介入栓塞治疗肺动静脉瘘3例临床分析

Clinical analysis of pulmonary arteriovenous fistula treated by interventional embolization: three case reports

目的总结分析肺动静脉瘘(pulmonary arteriovenous fistula,PAVF)介入栓塞治疗(interventional embolization,IVE)的治疗效果。方法回顾性分析福建省立医院血管与肿瘤介入科自2016年7月至2018年1月施行IVE的3例PAVF患者的临床资料。观察患者手术时间、术中出血量、病变血管直径、末梢血氧饱和度、血气分析氧分压、住院天数等指标。结果术中数字减影血管造影(digital subtraction angiography,DSA)明确诊断为肺动静脉瘘3例,其中右肾动静脉瘘合并右肺下叶动静脉瘘1例,右肺下叶前基底段、左肺上叶下舌段肺动静脉瘘1例,右肺上叶后段及左肺下叶外后基底段肺动静脉畸形1例。3例患者均行IVE治疗,术后均无并发症。手术持续时间范围为126~213min,术前末梢血氧饱和度介于84%~91%之间,氧分压介于71%~84%之间,术中出血量20~100ml,术后患者的住院天数为2~7d(中位数为4d),术后末梢血氧饱和度均保持在97%以上,氧分压在95%~105%之间。术后进行为期27~45个月的随访,均未出现手术后的长、短期并发症,生活质量较术前明显提高。结论IVE适用于PAVF,并已成为治疗PAVF的首选方法,该方法疗效肯定,但仍要注意术后反应性胸膜炎和肺纤维化等并发症。

Objective To summarize and analyze the therapeutic effect of pulmonary arteriovenous fistula(PAVF)treated by interventional embolization(IVE).Method The clinical data of 3 patients with PAVF who underwent IVE from July 2016 to January 2018 in the Department of Vascular Intervention of Fujian Provincial Hospital were retrospectively analyzed.Indexes such as operative time,intraoperative blood loss,diameter of diseased blood vessel,peripheral blood oxygen saturation,blood gas analysis oxygen partial pressure,and hospital stay were observed.Result Intraoperative digital subtraction angiography(DSA)confirmed 3 cases of PAVF,including one case of right renal arteriovenous fistula comorbid with right lower lobe arteriovenous fistula,one case of PAVF in anterior base segment of right lower lobe,left upper lobe and lower tongue segment,and one case of pulmonary arteriovenous malformations in the posterior upper lobe of the right lung and the posterior base segment of the external lower lobe of the left lung.Three patients were treated with IVE and no postoperative complications were observed.The procedure lasted between 126 and 213 minutes.Preoperative peripheral blood oxygen saturation ranged from 84% to 91%;oxygen partial pressure ranged from 71% to 84%, intraoperative blood loss ranged from 20 to 100ml;and length of stay ranged from 2 to 7 days, with a median of 4 days. Postoperatively, peripheral blood oxygen saturation consistently remained above 97%, while the oxygen partial pressure ranged between 95% and 105%. After 27 to 45 months of follow-up, no long-term and short-term complications were observed after the operation, and the quality of life was significantly improved. Conclusion IVE has emerged as the primary choice for the treatment of PAVF. It is effective, yet vigilance is required for postoperative reactive pleurisy and pulmonary fibrosis.