支气管动脉-肺循环瘘的DSA表现和介入治疗(附21例报告)

The DSA findings and the interventional therapy experience of bronchial artery to pulmonary circulation fistula(report of 21 cases)

目的 :总结支气管动脉 -肺循环瘘的DSA表现和介入治疗经验。方法 :2 1例咯血病人 ,经DSA证实存在支气管动脉 -肺循环瘘 ,根据血管瘘的类型、数目、瘘口的大小、循环时间选择不同种类和大小的栓塞剂对瘘口和病变血管进行栓塞。对其中 6例DSA可见到明确瘘口并且循环时间短于 1s的病人 ,先用明胶海绵颗粒对瘘口作预栓塞 ,然后用长约1mm的 5～ 0真丝线段进一步栓塞。其余 15例循环时间长于 1s者 ,直接用真丝线段进行栓塞。栓塞术后随访 3个月至半年 ,评估治疗效果。结果 :DSA表现为支气管动脉 -肺动脉瘘和支气管动脉 -肺静脉瘘者分别为 15例和 6例 ,同时合并肋间动脉 -肺循环瘘者 5例。其中 17例经支气管动脉栓塞后达到即刻止血效果 ,有 3例栓塞术后咯血量明显减少 ,经保守治疗后痊愈出院。总有效率为 95 .2 %。另 1例因肋间动脉和锁骨下动脉参与供血 ,未能有效止血 ,在介入术后 6h转胸外科手术治疗。经随访发现 ,有 2例分别在介入栓塞后 4个月和 11个月复发 ,5例在 19个月内死于肺癌合并症。结论 :支气管动脉 -肺循环瘘在咯血病人中是常见的血管异常 ,可加重咯血和心肺疾病的进展 ,经皮穿刺支气管动脉栓塞术是有效的治疗方法。

Objective:To analysis the DSA findings and interventional therapy experience of bronchial artery to pulmonary circulation shunt (BPS).Methods:BPS were confirmed by DSA in 21 patients with hemoptysis.The disorder vessels were embolized using various kinds and sizes embolism particles with according to the shunt tip and number, the shunt orifice size and circulation time.In 6 patients within 1 sec circulation time, the shunt orifices were pre-embolized using gelfoam particles,and 5～0 silk segments measuring about 1mm were used for compensative embolism.The remaining 15 patients beyond 1 sec circulation time were embolized only using silk segments.Results:According to DSA findings, bronchial artery to pulmonary artery shunt and bronchial artery to pulmonary vein shunt were confirmed in 15 and 6 patients, respectively.Among them,17 patients stop bleeding instantly after embolization, and the bleeding decreased significantly in 3 patients.The total effective rate was 95.2%.The remaining one was inefficiency due to the blood supply coming from intercostal arteries and subclavian artery,who was performed by surgical intervention 6 hours after embolization. The following-up revealed that hemoptysis re-occurred in 2 patients 4 months and 11 months respectively after embolization and 5 patients died due to pulmonary cancer within 19 months.Conclusion:BPS is a common vessel abnormality in the patients with hemoptysis.It can worsen hemoptysis and cardio-pulmonary diseases. Transcatheter embolization of the bronchial artery is an effective therapeutic means.