支气管扩张症伴咯血患者的供血动脉解剖学分型及DSA表现

目的分析支气管扩张症伴咯血患者的供血动脉解剖分型及DSA表现。方法收集接受经导管动脉栓塞术的支气管扩张症伴咯血患者62例,其中男36例,女26例,结合胸部CT及术中数字减影血管造影(DSA)确定其供血动脉,分析供血动脉的解剖学分型及DSA表现。结果 62例患者均在栓塞过程中接受DSA检查,21在栓塞治疗前接受增强CT检查。DSA示10例单纯支气管动脉供血;34例异常支气管动脉供血,其中主干型14例(支气管动脉增粗、纡曲扩张11例,支气管动脉瘤样扩张3例),网状型12例,多种动脉交通吻合型8例;18例非支气管源性动脉供血,其中肺动脉供血4例,肋间动脉供血12例,支气管动脉与肺动脉形成吻合血管网者2例。结论支气管扩张症伴咯血与供血动脉的解剖异常有关,了解其解剖特点有利于临床开展介入治疗。     

多层螺旋CT血管成像在支气管动脉灌注化疗前的定位价值

目的探讨多层螺旋CT血管成像(MSCTA)在支气管动脉(BA)灌注化疗前的定位价值。方法分析15例经支气管动脉介入治疗前的的肺癌病例,中央型13例,周围型2例。15例均行螺旋CT增强扫描,后传至工作站利用多平面重组(MPR)、最大密度投影(MIP)和容积再现(VR)等后处理技术观察支气管动脉。结果13例中央型肺癌均由肿瘤性支气管动脉供血,重建图像清晰显示肿瘤性支气管动脉的起点、分支情况及走行特点;其中2例右侧肿瘤性支气管动脉与肋间动脉共干。2例周围型肺癌中有1例由肿瘤性支气管动脉供血,1例找不到明确发自支气管动脉的供血血管。结论多层螺旋CT血管成像能够显示肺癌特别是中央型肺癌的肿瘤性支气管动脉并能为经支气管动脉灌注化疗提供准确定位。     

双血供CT灌注用于肺部疾病研究进展

双血供CT灌注(DI-CTP)可同时定量评估肺动脉(PA)和支气管动脉(BA)供血,显示病理状态下二者供血比例变化,提供肺部病灶形态学和血流动力学信息,有助于鉴别良、恶性病变。本文就DI-CTP用于肺部疾病研究进展进行综述。     

支气管肺癌的肿瘤血管与染色、病理学和预后相关性

目的探讨肺癌肿瘤血管与染色同病理学的相关性及其对介入治疗预后的影响。方法所有患者按年龄、性别、病灶大小和位置、病理学、肿瘤供血动脉、肿瘤血管、肿瘤染色、手术方式、治疗次数、首次发病时间、首次介入治疗时间、生存时间分组统计,并输入SPSS12.0软件进行系统分析。结果40例连续血管造影随访,治疗前肿瘤染色明显者18例,肿瘤染色一般者9例,肿瘤染色欠佳者13例;末次治疗后血管造影,肿瘤染色明显者9例,肿瘤染色一般者17例,肿瘤染色欠佳者14例;治疗前后肿瘤染色改变统计学处理(P<0.01),其中支气管动脉供血35例(35/40,87.5%),同时肺动脉参与供血者4例(10%),鳞癌和腺癌支气管动脉供血32例(80%)。病理学、介入方法和生存时间之间的相关分析显示有明显统计学意义。结论肺癌的肿瘤血管与肿瘤染色同组织病理学分型不相关,而与病理学分级呈负相关,即分化程度越低,肿瘤血管和染色越丰富。鳞癌和腺癌以支气管动脉供血为主。血管内介入治疗能明显减少肿瘤血管和肿瘤染色,提高支气管动脉内治疗效果。     

双低剂量螺旋CT双期扫描在胸痛三联征的可行性研究

目的 探讨双低剂量肺动脉期与胸主动脉期螺旋CT双期扫描在胸痛三联征的可行性研究。方法 将收集于中山大学孙逸仙纪念医院的156例患者分为2组,观察组（39例）为急性胸痛患者,行双低剂量肺动脉期与胸主动脉期螺旋CT双期扫描,包括肺动脉CT血管造影（CTPA）（CTPA1组）、心脏冠状动脉CT血管造影（CCTA）（CCTA1组）和胸主动脉CT血管造影（TCTA）（TCTA1组）一次成像。常规组（117例）分别实施CTPA（CTPA2组,39例）、CCTA（CCTA2组,39例）和TCTA（TCTA2组,39例）。所有图像分别由两位医师重建并对其进行分级评分,分别记录、分析和比较两组图像质量、CT值、图像对比噪声比（CNR）和有效辐射剂量。结果 观察组肺动脉、心脏冠状动脉及胸主动脉与常规组的对应血管评分,K值分别为0.60、0.68和0.61,其一致性好。观察组与常规组对应血管图像的CNR及平均CT值均没有统计学差异（P>0.05）。观察组的有效辐射剂量与常规组中CCTA2组没有统计学差异（P>0.05）;观察组有效辐射剂量分别与常规组中CTPA2组及TCTA2组有统计学差异（P<0.05）,且常规组两组均高于观察组。结论 双低剂量螺旋CT双期扫描的图像质量满足临床需求且有效辐射剂量较低。     

CT平扫预测咯血患者非支气管动脉体循环侧支供血

目的评价CT平扫预测咯血患者非支气管动脉体循环侧支供血的价值。方法对56例咯血患者术前行螺旋CT平扫。将邻近病变肺实质的胸膜增厚大于3mm作为咯血患者存在侧支供血的标准。以血管造影结果为参照,与患者胸部CT扫描进行比较,对CT预测不同部位肺部病变存在侧支供血的敏感性、特异性及准确性进行评价。结果CT预测侧支供血总的敏感性、特异性及准确率分别为72．73％、95．00％及91．11％。其敏感性于上外侧及后外侧病变相对较高,而于前内侧、肺底及下内侧病变相对较低;特异性及准确性于以上各部位均较好。结论CT平扫在一定程度上能够预测咯血患者侧支供血,对选择性血管造影及栓塞治疗具有重要参考价值。     

柔性减影CE-Boost技术对CT肺动脉造影图像质量的影响

目的 观察柔性减影CE-Boost技术对CT肺动脉造影(CTPA)图像质量的影响。方法 回顾性分析66例疑诊肺栓塞(PE)患者的肺部CT平扫及CTPA资料,对平扫期和增强动脉期图像进行薄层重建,以Sure-Subtraction Lung软件行柔性减影,获得CE-Boost序列图像。将重建后增强动脉期图像(A组)与CE-Boost图像(B组)上传至Toshiba Vitrea后处理工作站,测量肺动脉及其分支CT值,计算信噪比(SNR)及对比噪声比(CNR);并由2名影像科医师采用5分法对图像质量进行主观评分。结果 B组肺动脉主干,左、右肺动脉干,左、右上肺动脉分支及左、右下肺动脉分支的CT值、SNR值及CNR值均高于A组(P均＜0.001)。B组图像主观评分5(4,5)分,高于A组的2(1,2)分(Z=－4.980,P＜0.001),且2名医师对A、B组图像质量评分的一致性较高(Kappa=0.896)。结论 柔性减影CE-Boost技术可提高CTPA图像质量。     

介入治疗胃肠间质瘤致急性消化道大出血1例

<正>患者男,24岁,因不育接受睾丸活检术,术后8h排大量柏油便及陈旧血块,并出现失血性休克。腹盆CT:平扫见左中腹4.2cm×3.8cm肿块,增强后肿块明显强化(图1A、1B)。遂行急诊介入治疗。腹主动脉、腹腔动脉、肠系膜上动脉及肠系膜下动脉造影见肠系膜上动脉空回肠分支增粗及异常染色影,边界清晰(图1C),考虑为小肠富血供肿瘤,进一步超选择至靶动脉造影确认后,以予2ml 500~700μm微球(Embosphere)及4枚微弹簧圈栓塞,栓塞后造影示靶血管闭塞,异常染色消失(图1D)。介入治疗后患者病情稳定,2天后接受外科肿瘤切除术。     

膈下动脉参与肝脏肿瘤供血的影像与介入治疗

目的研究膈下动脉参与肝肿瘤供血的影像表现和介入治疗效果.方法经血管造影证实膈下动脉参与肝脏肿瘤供血17例,男12例,女5例,年龄32～59岁,既往均有肝动脉化疗栓塞史(2-6次).膈下动脉造影用5FCobra导管,对向肿瘤供血的膈下动脉分支行栓塞治疗,1例用同轴微导管.结果肝脏肿瘤均为巨块型,位于肝脏上部,接近膈肌或/和肝包膜.膈下动脉造影均为右侧膈下动脉以终末支方式参与肿瘤供血,栓塞治疗成功.术后复查CT显示肿瘤缩小或/和瘤区碘油积聚增多,末次治疗前13例AFP＞20μg/L,术后逐渐下降或正常.结论位于肝脏上部、接近膈下或/和肝包膜的肿瘤可接受右膈下动脉供血,在经膈下动脉栓塞治疗时应注意膈肌痉挛并发症.     

间接门静脉造影判断肝血管瘤血供来源

探讨间接门静脉造影对判断肝血管瘤血供来源的临床价值。方法78例经临床和影像学资料证实的肝血管瘤患者,其中56例经肠系膜上动脉行间接门静脉造影,观察造影表现及对肿瘤供血情况,所有患者经动脉途径进行栓塞治疗,术后2～3个月CT、B超随访观察疗效。结果间接门静脉造影示门静脉显影清晰,未见异常扩张、畸形,且均未见向肿瘤供血;部分患者门静脉造影实质期瘤体呈低密度充盈缺损区,瘤体大者门静脉分支被推移。所有肝血管瘤都由肝动脉供血,栓塞术后随访有效率达84.6%。结论间接门静脉造影能在生理状态下对肝血管瘤患者门静脉进行观察,可为判断肝血管瘤血供来源及决定栓塞治疗方案提供帮助。     

生物制剂与抗癌药联合动脉导管灌注 治疗中晚期肺癌临床应用

目的应用生物制剂与抗癌药联合支气管动脉导管灌注治疗中晚期肺癌,探讨其临床价值。方法中晚期肺癌(转移瘤7例)21例,分别经支气管动脉灌注,支气管动脉、内乳动脉的部分血管栓塞,同时经支气管动脉或肺动脉灌注淋巴激活因子杀伤(LAK)细胞(10~15亿)和高聚金葡素(3000~6000 U)等免疫生物剂。结果21例肺内病灶均见不同程度的缩小,数目减少,有效率达到100%。其中3例肺内肿块完全消失,5例肺肿块显示明显缩小,并行手术切除,6例肺转移灶明显缩小。随访1.5年,其生存率100%,两年以上生存率为85.7%(18/21),与化疗相关的毒副作用明显减轻。结论生物制剂与抗癌药联合支气管动脉导管灌注治疗中晚期肺癌,有利于提高疗效和生存质量。     

原发性肝癌肝动脉灌注栓塞术后肿瘤存活区的血液供应

目的采用多层螺旋CT(MSCT)平扫及增强双期扫描,研究原发性肝癌(HCC)经肝动脉灌注碘化油栓塞术(LPTACE)后肿瘤存活区(VTA)的血液供应,以期对再治疗方案和途径的选择提供有价值的信息。方法38例HCC患者共55个病灶,经57次LPTACE后行MSCT平扫及增强双期扫描,根据增强扫描不同时期的强化表现,将VTA的血液供应分为四种类型:肝动脉供血型、门静脉供血型、双重供血型及少血供型;统计各种血供类型的比例,并与术前肿瘤血供进行比较。结果38例患者行57次LPTACE后的肿瘤存活区在平扫表现为肿瘤内栓塞碘化油之间及周围非坏死低密度影,其CT值为(37.71±7.78)Hu。低密度肿瘤存活区有四种类型的血液供应,分别为:肝动脉供血型(29例)、门静脉供血型(2例)、双重供血型(22例)、少血供型(4例)。与术前肿瘤血供比较,门静脉参与供血有增加。结论HCC经LPTACE术后肿瘤存活区血供以肝动脉供血和肝动脉、门静脉双重供血为主,单纯门静脉供血及少血供较少。与LPTACE术前相比,门静脉对肿瘤存活区的供血有增加。     

动脉造影初步分析肝脏Ⅸ段肿瘤肝动脉血供

目的 研究肝脏Ⅸ段肿瘤的肝动脉血供方式.方法 回顾性分析8例肝脏Ⅸ段肿瘤病例的CT和DSA资料,由CT做出定位诊断,在DSA上观察肝脏Ⅸ段肿瘤的肝动脉血供情况.观察肝动脉的各级分支,统计这些分支向病灶供血的例数,分析肝脏Ⅸ段肿瘤的肝动脉血供来源.根据病灶染色情况,以积分法确定这些肝动脉分支向病灶供血的多少.结果 肝脏IX段肿瘤的肝动脉血供来源十分广泛,MHA、RPHA、RAHA、LMHA和CallA向病灶供血的例数分别是7、6、5、5和2例(X2=2.800,P=0.592,Chi-square test),积分分别是15、13、11、6和2分(X2=9.657,P=0.047,Kendall's W).RHA和LHA的积分分别是38和9分(Z=-2.243,P=0.025,Wilcoxon).未见CyA和LLHA向病灶供血的病例.结论 RHA和LHA系统都有可能向肝脏Ⅸ段肿瘤供血,RHA供血比LHA多.MHA、RPHA、RAHA、LMHA是主要的供血支.     

A case of racemose hemangioma of the right bronchial artery and intercostal to pulmonary arterial anastomosis

We reported a case of racemose hemangioma of the bronchial artery and intercostal to pulmonary arterial anastomosis. A 67-year-old woman was admitted because of repeated hemoptysis. Bronchoscopic examination revealed a torous lesion of the right B⁷ bronchus. Intercostal angiography demonstrated communications between right dilated, meandered intercostal arteries and right pulmonary artery. Bronchial angiography showed dilatation and convolution of the right bronchial artery. Angiographic embolization of the right bronchial artery and the right intercostal artery was underwent. There was no recurrence of hemoptysis one year after the embolization procedure. We think that angiographic embolization is an effective method of treatment of hemoptysis due to racemose hemangioma of the bronchial artery and intercostal to pulmonary arterial anastomosis.     

Anatomical bases for bronchial arterial revascularization in double lung transplantation]

A study of the bronchial arterial blood supply was conducted to facilitate in surgical attempts of bronchial revascularization in double lung transplantation. This study consisted of 20 cadaveric anatomical dissections of the bronchial arterial blood supply as well as a retrospective review of 50 bronchial arteriograms. The right bronchial tree was supplied by an artery originating from the right intercostal bronchial arterial trunk in 76 to 95% of the cases. This artery also supplied the distal trachea and the carina in over 80% of cases as well as the proximal left bronchial tree via a network of small collaterals found in the subcarinal compartment and adventitial tissues located on the anterior surface of the descending aorta. A common arterial trunk for both the right and left bronchial trees was found in 12 of the 20 dissections (60%). Left bronchial arteries were much smaller and less consistent. Proximity of the bronchial arteries orifices was frequently observed: in 10 of the 20 dissections it allowed simultaneous reperfusion of more than one vessel. To maintain the vascular anastomotic network in between the right and left trees, extensive vascular dissection and carinal resections are prohibited. This will allow revascularization of the whole tracheal bronchial tree via the supply of the origin of the RICBA.     

Video-assisted thoracoscopic surgery for ligation of anomalous systemic arterial supply to pulmonary sequestration

A 52-year old female with anomalous systemic arterial supply to pulmonary sequestration was reported. The patient was admitted because of an abnormal lung shadow on chest X-ray film. Computed tomography (CT) showed an anomalous systemic arterial supply to pulmonary sequestration of the left lower lung without lung infection. Video-assisted thoracoscopic surgery for ligation of the anomalous systemic artery was performed. Postoperative course has been uneventful for 14 months after surgery. Blood supply increased to the left lower lung by 3-dimensional CT after surgery. The ligation of anomalous systemic arterial is enough for this disease.     

Surgical resection of cardiac metastasis of thyroid cancer--a case report

A case of metastasis of thyroid cancer into the cardiac cavity is described. A 73-year-old female suffered from sudden chest pain, dyspnea and dizziness and admitted to a local clinic on emergency. A diagnosis of bilateral multiple pulmonary infarction was made by lung perfusion scintigraphy. However, a mass migrating between the right atrium and the right ventricle across the tricuspid valve was demonstrated by echocardiography, and the patient was referred to us under a diagnosis of myxoma complicated with pulmonary infarction. Incision of the right atrium disclosed a gelatinous mass resembling frog eggs, attached to the right ventricle side of the anterior cusp of the tricuspid valve and swinging across the orifice of the valve. The gross lesion was removed completely. Since the histological diagnosis was clear cell carcinoma, no surgery was performed on the pulmonary artery. Postoperative re-examination by ultrasonography and CT revealed thyroid cancer as the primary lesion.     

Angiographic and histopathological study on bronchial-to-pulmonary vascular anastomoses on explants from patients with cystic fibrosis after bronchial artery embolisation

Labelled backgroundHaemoptysis is a life-threatening complication of cystic fibrosis (CF). One treatment is bronchial artery embolisation (BAE) using embolic-microspheres (EMs). During BAE, pulmonary arteries can be seen on digital subtracted angiography while iodine containing contrast material injection is performed in the bronchial artery. This suggests that EMs could go from bronchial to nontarget pulmonary arteries. The aim was to evaluate if EMs could be found inside pulmonary arteries on lung explants after BAE in transplanted CF patients.MethodsRetrospective observational study including patients with CF who underwent lung transplantation and had previously needed BAE. Clinical, chest CT angiography, and angiographic data were reviewed from medical records. Pathology examination of lung explants was performed to analyze the EMs anatomical localisation.ResultsEight patients were included between 2013 and 2015, four males with a mean age of 29 (19-45) years. All patients had bronchial artery hypertrophy on CT and bronchial-to-pulmonary artery shunting during BAE. On pathology examination, EM ≤800 µm were found in the pulmonary arteries in all patients and were responsible for distal branch occlusions. Two pulmonary infarcts were observed on CT angiography after BAE and confirmed histopathologically.ConclusionsEM migration from the bronchial to pulmonary arteries is a common occurrence after BAE in patients with advanced stage CF. Although BAE is a highly effective means of controlling haemoptysis in CF, studies on the optimal particle size are needed to preserve pulmonary artery circulation, because these results suggest that low size EMs could lead to nontarget embolisation.     

Chest wall implanted reservoir for bronchial arterial infusion of antineoplastic agents in high-aged lung cancer patients.

Arterial infusion therapy has been actively adopted to treat cancerous lesions in various clinical fields. In the past, a one-shot infusion via the bronchial artery has been used in lung cancer patients. In order to improve the patient's quality of life and enhance his/her response to chemotherapy, we have developed a chest wall implanted reservoir system for arterial infusion of antineoplastic agents via the bronchial artery. A slender catheter was inserted in a bronchial artery through the left subclavian artery (first case through the right femoral artery) in five patients over 75 years old with lung cancer. The reservoir was embedded in the chest wall (first case in the femoral region) and the antineoplastic agents were infused repeatedly on an outpatient basis. In two patients, accumulation of 99mTc-MAA in the primary lung tumor was confirmed by RI (radio-isotope) angiography. All patients could lead an active daily life during treatment. The results indicate that satisfactory therapeutic effects as well as an improvement of the patient's quality of life can be expected with this treatment modality, especially in case of the chest-wall reservoir with an indwelling catheter in the left subclavian artery.