肺动静脉瘘的诊断与治疗

目的归纳肺动静脉瘘（ＰＡＶＦ）的发病原因、临床表现特征及合并症，分析各种诊断方法的优缺点，以提高对ＰＡＶＦ的认识，从而提高诊断水平和治疗效果。方法回顾分析２２例临床病例，结合文献资料总结经验、教训，提高认识。结果２２例中１２例行肺部手术，其中９例术后症状完全消失；１例多发ＰＡＶＦ行左下肺动脉结扎，术后症状明显改善；另１例行左全肺切除，术后早期症状改善，半年后失访。１例弥漫性ＰＡＶＦ行全肺切除，术后１年死亡；另外１０例弥漫性ＰＡＶＦ中５例行非肺部手术，患者能够耐受手术，但ＰＡＶＦ症状改善不明显；５例未行任何特殊治疗，失访。结论超声心动声学造影是确定ＰＡＶＦ的最简单、有效、创伤小的检查方法；肺动脉造影可确定ＰＡＶＦ部位、大小及范围；手术治疗效果肯定，但必须恰当选择适应证。

Diagnosis and management of pulmonary arteriovenous fistula

Objective To evaluate the causes, characteristics of clinical manifestations and the complications of pulmonary arteriovenous fistula, to analyse the advantages and disadvantages of diagnostic methods, and to improve the efficacy of treatment. Methods Through reviewing reference articles and 22 cases. Results Arteriovenous fistulae in 12 of 22 cases were removed by pulmorary resection, of whom 9 were completely recovered, 1 recovered significantly, 1 got better in early stage but could not be follow up 6 months later, 1 died one year after operation. Five out of the 22 cases were surgically intervened with other non pulmonary operations, of whom 4 recovered but the clinical apperances of PAVF were not obviously improved, 1 died shortly after operation. The others of 22 cases (5 cases) were not specially treated and not be follow up. Conclusion Echocardiography is the most simple, efficient method for diagnosis of PAVF. Pulmonary angiography can identify the size, location and profile of the PAVF. The results of removal of the fistulae are excellent, however the candidates should be selected strictly.