经导管栓塞治疗肺动脉假性动脉瘤合并咯血29例临床分析

Transcatheter embolization of pulmonary pseudoaneurysm with hemoptysis:a clinical analysis of 29 cases

目的分析经导管栓塞治疗肺动脉假性动脉瘤合并咯血的29例患者的临床资料,为肺动脉假性动脉瘤合并咯血治疗提供参考。方法回顾性研究2018年6月至2021年12月在江西省胸科医院接受治疗的29例肺动脉假性动脉瘤合并咯血患者,收集患者年龄、性别、咯血程度、合并疾病,肺动脉假性动脉瘤位置、大小、治疗方式、造影分型、技术成功、临床成功、随访等临床资料,比较临床成功及失败患者的资料。结果本研究肺动脉假性动脉瘤最常见的位置是右肺上叶,共12例(41.4%),假性动脉瘤的大小为3~45 mm。根据患者胸部CTA及造影表现将肺动脉假性动脉瘤分为四组,其中A型(肺动脉主干造影可显示)8例,B型(肺动脉造影主干造影不显示)16例,C型(体动脉造影显示)3例,D型(体、肺动脉造影均不显示)2例。临床成功和临床失败患者的假性动脉瘤位置、最大直径、造影分型情况及治疗方式比较,差异无统计学意义(P>0.05)。结论根据患者体动脉及肺动脉造影对肺动脉假性动脉瘤进行分类,结合胸部CTA选择个体化治疗方案,对肺动脉假性动脉瘤合并咯血的血管内治疗是安全有效的。

Objective To analyze the clinical data of 29 patients with pulmonary artery pseudoaneurysm combined with hemoptysis treated with transcatheter embolization,and provide reference for the treatment of pulmonary artery pseudoaneurysm combined with hemoptysis.Methods A retrospective study was conducted on 29 patients with pulmonary artery pseudoaneurysm complicated with hemoptysis who received treatment at Jiangxi Chest Hospital from June 2018 to December 2021.Clinical data including age,gender,degree of hemoptysis,comorbidities,location,size,treatment method,imaging classification,technical success,clinical success,and follow-up were collected to compare the clinical success and failure of patients.Results In this study,the most common location of pulmonary artery pseudoaneurysm was the right upper lobe,with 12 cases(41.4%),and the size of pseudoaneurysm was 3~45 mm.According to the chest CTA and angiographic findings,pulmonary artery pseudoaneurysm was divided into four groups,including 8 cases of type A(pulmonary arteriography can be displayed),16 cases of type B(pulmonary arteriography can not be displayed),3 cases of type C(systemic arteriography can be displayed)and 2 cases of type D(pulmonary arteriography can not be displayed).There were no significant differences in the location,maximum diameter,angiographic classification and treatment of pseudoaneurysm between the patients with clinical success and those with clinical failure(P>0.05).Conclusion Classifying pulmonary artery pseudoaneurysm based on patient arterial and pulmonary arteriography,combined with chest CTA to choose individualized treatment plans,is safe and effective for intravascular treatment of pulmonary artery pseudoaneurysm combined with hemoptysis.