| 王巍颋,余亮,涂永辉,熊景良.肺部体循环CTA在咯血介入栓塞治疗中的临床价值[J].实用中西医结合临床,2021,21(24): |
| 肺部体循环CTA在咯血介入栓塞治疗中的临床价值 |
| The clinical value of pulmonary systemic circulation CTA in the interventional embolization treatment of hemoptysis |
| 投稿时间：2021-10-25 修订日期：2021-11-11 |
| DOI： |
| 中文关键词: 咯血 支气管动脉 介入栓塞 |
| 英文关键词: Hemoptysis Bronchial artery Interventional embolization |
| 基金项目:江西省卫生计生委科技计划（20183432） |
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| 中文摘要: |
| 【摘要】目的：分析不同咯血患者的主要出血的责任血管，探讨CTA对不同责任血管的检测效率以及TAE的疗效。方法：回顾性分析2019年-2020年在江西省胸科医院的TAE治疗的大咯血患者，术前经过CTA检查。其中结核患者66名，支扩患者29名，肿瘤患者14名，感染患者12名。另外收集30名正常组患者。检测统计不同患者的主要咯血责任血管，分析咯血患者的BA的直径与正常组的差异性，分析CTA与DSA检出责任血管数量的差异性和一致性，随访TAE治疗后的有效率。结果:感染组主要责任血管为支气管动脉约92.3%；结核组主要责任血管为支气管动脉约38.1%、肋间动脉约26%、膈下动脉约13.2%；支气管扩张组主要责任血管支气管动脉约40%、肋间动脉约22.42%、膈下动脉约14.3%、胸廓内动脉约10.8%；肿瘤组主要责任血管支气管动脉约49.3%、肋间动脉约29%、胸廓内动脉约8.4%。BA主要起源于T4-7降主动脉壁约88.5%。咯血患者的BA直径与正常组相比，P<0.05,存在差异性。CTA对比DSA:左、右支气管动脉、食管固有动脉、肋颈干Sig值>0.05，差异性小，一致性>0.75,一致性高；异位的支气管动脉、胸廓内动脉Sig值<0.05差异性较大，一致性检测小于0.75大于0.4,一致性中等；肋间动脉、膈下动脉Sig值<0.05差异较大，一致性>0.75,一致性高。随访TAE术后患者，治疗效果良好65.3%，治疗有效率95.9%，大咯血复发率4%。结论：大咯血患者存在多重供血的可能，CTA对咯血的责任血管有着比较高的敏感性，部分责任血管有一定的误差率，能够起到较好的术前指导和预判工作。TAE术后有效率较高，复发率较少。 |
| 英文摘要: |
| 【Abstract】Objective: To analyze the main blood vessels responsible for bleeding in different hemoptysis patients, and To explore the detection efficiency of CTA on different blood vessels responsible for hemoptysis and the curative effect of TAE. Methods: Retrospective analysis of patients with massive hemoptysis treated with TAE in Jiangxi Chest Hospital from 2019 to 2020, who underwent preoperative CTA examination. Including 66 tuberculosis patients, 29 bronchiectasis patients, 14 tumor patients, and 12 infected patients. And 30 patients in the normal group were collected in addition . Detect and count the main blood vessels responsible for hemoptysis in different patients, analyze the difference between the diameter of BA of hemoptysis patients and the normal group, analyze the difference and consistency of the number of responsible blood vessels detected by CTA and DSA, and follow up the effective rate after TAE treatment. Results: The main responsible vessels of infection group were bronchial artery (92.3%). TB group mainly responsible blood vessels were bronchial artery(38.1%), intercostals arteries(26%), inferior phrenic artery(13.2%) ; Bronchiectasis group mainly responsible vessels were bronchial artery (40%), intercostals arteries(22.42%), inferior phrenic artery (14.3%), thoracic artery (10.8%); In the tumor group, the main responsible vessels were bronchial artery (49.3%), intercostal artery (29%) and internal thoracic artery (8.4%).BA is mainly originated from T4-7 descending aorta wall(88.5%). The BA diameter of patients with hemoptysis was different from that of the normal group (P<0.05). CTA vs. DSA: Sig values of left and right bronchial artery, esophageal proper artery and costocervical trunk were >0.05, with small difference and high consistency >0.75. Sig values of ectopic bronchial artery and internal thoracic artery <0.05 had great difference, and the consistency test was less than 0.75 and greater than 0.4, indicating moderate consistency. Sig values of intercostal artery and inferior phrenic artery <0.05 were significantly different with consistency >0.75, indicating high consistency.Follow-up of patients after TAE,65.3% had good treatment effect, the effective rate was 95.9%, and the recurrence rate of massive hemoptysis was 4%. Conclusion: Patients with massive hemoptysis have the possibility of multiple blood supply. CTA has a high sensitivity to the responsible vessels of hemoptysis, and some responsible vessels have a certain error rate, which can play a good preoperative guidance and prediction. TAE has higher postoperative efficiency and less recurrence rate. |
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