支气管Dieulafoy病活检大出血窒息复苏成功1例并文献复习

目的 探讨支气管Dieulafoy病临床表现、诊断及治疗方法.方法 结合我院收治的1例支气管Dieulafoy病的临床资料及国内外文献报道的病例进行综合分析.结果 患者男性,70岁,反复间断咯血30年,大咯血8 h住院,胸部平片及CT未发现异常,行支气管检查发现气管黏膜呈"蚯蚓"样突起,活检过程中突然出现大出血窒息,经抢救复苏成功,后经病理及肺血管造影证实气管黏膜血管异常,考虑支气管Dieulafoy病,行栓塞治疗后好转.结论 支气管Dieulafoy病文献报道较少,发病原因不详,可能与支气管肺动脉先天发育异常和(或)后天的慢性炎症刺激、损伤有关,文献报道少可能与认识不足有关.遇有不明原因大咯血需行气管镜检查时,气管镜检查发现气管黏膜呈"蚯蚓"样突起,应想到该病的可能,不要盲目活检,应想到有大咯血窒息可能,如确需活检,应备好抢救措施.     

支气管Dieulafoy病1例并文献复习

目的 介绍1例支气管Dieulafoy病并复习国内外文献,以提高对这一少见病的认识.方法 对1例确诊为支气管Dieulafoy病患者的临床表现及检查结果进行分析,并结合文献讨论其临床特点、诊断及治疗.结果 支气管Dieulafoy病是一种病因尚未明确的以支气管黏膜下畸形动脉破裂出血为病理特征的罕见疾病,临床常见表现为反...     

支气管Dieulafoy病1例

<正>Dieulafoy病是引起消化道大出血的原因之一,该疾病的特征为黏膜下畸形动脉破裂出血。该病由法国医生Dieulafoy 1898年首次报道,多发生于消化系统,而支气管Dieulafoy病则较为罕见,常以致命性大咯血为首发症状[1],在临床上非常容易造成漏诊和误诊。现报道一例于我院近期诊断的支气管Dieulafoy病,以期提高大家对此病的认知及警惕性。临床资料患者女性,63岁,因反复咯血40年余,再发3天入院。40余年前,始无明显诱因反复出现咯血,     

少见病因致咯血四例临床分析

目的提高临床对少见原因引起咯血的诊疗水平。方法对4例已经明确诊断的少见原因引起咯血患者的临床资料进行分析，并结合文献复习。结果4例咯血病因分别是肋间动脉-肺动脉瘘（intercostal—to—pulmonary arterial fistula，IPAF）、肺内错构瘤（pulmonary hamartoma，PH）、单纯性左肺动脉缺如（absence of the left pulmonary artery，ALPA）、原发性肺动脉高压（primary pulmonary hypertension，PPH），均为临床少见病例。IPAF首选支气管动脉造影及栓塞；肺内错构瘤为肺部良性肿瘤，结合病史和影像一般可以获得初步诊断，确诊及治疗依赖手术；ALPA影像检查可以获得诊断，如果合并大咯血，手术治疗是最佳的临床选择；PPH经X线胸片、超声心动图即可获得初步诊断，右心导管检查是确诊的可靠依据。结论咯血为呼吸系统常见症状之一，但少见原因引起的咯血容易误诊。遇到不明原因的咯血患者应详细询问病史并结合临床检查，才能获得正确的诊断及治疗。     

急诊内镜联合选择性动脉造影诊治Dieulafoy病4例临床分析

目的探讨急诊内镜联合选择性动脉造影诊治Dieulafoy病的临床价值。方法我院消化内科2009年1月1日～2010年12月31日共收治Dieulafoy病18例,对其中急诊内镜联合选择性动脉造影救治Dieulafoy病所致上消化道大出血4例进行临床分析,通过急诊内镜联合选择性动脉造影的协同应用,观察对出血部位、病因的诊断价值和止血效果。结果 4例患者均在就诊1～24h内胃镜检查确诊Dieulafoy病,其中3例给予镜下钛夹止血或药物喷洒止血后仍有活动性出血随即行选择性动脉造影血管栓塞治疗,1例因镜下出血表现为喷射样,并血压下降,给予病灶旁钛夹标记后随即行选择性动脉造影血管栓塞治疗。本组4例在选择性动脉造影同时结合内镜所见均给予相应病变血管弹簧栓或明胶海绵栓塞止血治疗并成功止血。结论急诊内镜联合选择性动脉造影血管栓塞术协同诊治Dieulafoy病所致消化道出血,两者互为补充,是一种安全、有效、可靠的诊治方法。     

支气管动脉-肺动脉瘘致大咯血一例

支气管动脉－肺动脉瘘致大咯血一例王羡懿刘晖陈鹏隐源性咯血占大咯血的４％～１８％，处理颇为困难。文献报道［１］出血局部支气管动脉常有异常改变。我们在ＰｈｉｌｉｐｓＨＢ２０００型数字减影机下行选择性支气管动脉造影（ＢＡＧ）及支气管动脉栓塞（ＢＡＥ），确诊...     

选择性支气管动脉栓塞治疗大咯血的临床应用

目的研究选择性支气管动脉栓塞治疗大咯血的临床应用。方法对15例大咯血病人行支气管动脉造影后，对异常支气管动脉用明胶海绵进行栓塞。结果10例咯血停止，4例咯血渐止，1例术后复发。结论选择性支气管动脉栓塞对大咯血患者是一种有效、安全、简便的治疗方法。     

双肺支气管动脉畸形反复大咯血合并支气管动脉瘘及肺栓塞1例

正咯血是呼吸内科常见的症状,而支气管动脉畸形是引起大咯血的罕见原因之一,是呼吸系统疾病的急危重症~([1]),如不及时抢救治疗,可因血液淤积窒息而危及患者生命。据统计,咯血原因中支气管动脉畸形仅占2%~([2]),且少部分患者合并支气管扩张或肺结核等能引起咯血的疾病~([3]),容易造成误诊或漏诊。现就我院收治的确诊为双肺支气管动脉畸形咯血合并支气管动脉-肺动脉瘘及双肺肺栓塞患者1例,报道如下。     

支气管动脉栓塞对治疗大咯血的近期疗效观察及再发危险因素分析

目的探讨支气管动脉栓塞对治疗大咯血的近期疗效,分析影响再发咯血的危险因素。方法收集2012年1月至2017年3月重庆市职业病防治院呼吸内科收治的因大咯血行支气管动脉栓塞治疗的80例患者的临床资料。术后进行1年的随访,记录患者术后即时止血率,及30 d,90 d,12个月三个时间点的累计咯血控制率及再治疗措施、疗效。以χ2检验、Logistic风险模型分析影响患者短期内再发咯血的危险因素。结果 74例患者在行栓塞治疗后,术后24 h内咯血症状消失,即时有效率为92.5%(74/80)。11例在术后30d内复发咯血,7例患者在术后90d内新发咯血,仅有3例患者在术后12个月内复发咯血,术后30 d、90d、12个月,3个时间点的累计咯血控制率分别为86.25%(69/80)、77.5%(62/80)、73.75%(59/80)。单因素分析结果显示,患者短期内再发咯血与病程长短、是否存在支气管动脉-肺动脉分流相关(P0.05)。但与患者年龄、性别、疾病的良恶性、病灶数量、栓塞剂类型、术前24 h咯血量无关(P0.05)。将所有危险因素纳入Logstic回归模型进行多因素分析,结果发现仅有支气管动脉-肺动脉分流是影响患者短期内再发咯血的独立性危险因素。结论支气管动脉栓塞术对大咯血近期疗效确切可靠,术后30 d内咯血最易复发。支气管动脉-肺动脉分流是影响患者短期内再发咯血最主要危险因素。     

重视肺动脉瘤性大咯血的诊断与介入治疗

肺部高压的支气管动脉与肺静脉构成体循环,低压的肺动脉与肺静脉构成肺循环,支气管动脉、肺动脉和肺静脉三种血管构成肺部两套循环系统。体循环的高压动脉形成动静脉畸形包括支气管动脉-肺静脉畸形和支气管动脉-肺动脉畸形,动静脉畸形的供养动脉、畸形血管团和引流静脉极易形成动脉瘤,动脉瘤破裂引发大咯血。而肺动脉瘤少见,易被漏诊,肺动脉瘤的血供可单独来源于肺循环或体循环,也可同时累及肺循环和体循环,肺动脉瘤破裂大咯血单纯体循环动脉栓塞难以控制。因此,要重视大咯血患者肺动脉瘤的诊断与介入治疗。     

Right tracheal bronchus with anomalous ramification of the bronchial artery disclosed during an episode of hemoptysis]

A 63-year-old woman was referred to our hospital on June 18th, 1998 during an episode of hemoptysis that had lasted for 6 days. She had no hemorrhagic diathesis and no history of pulmonary disease. Chest X-ray films disclosed a ground-glass opacity in the right upper lung field. Bronchoscopic examination revealed bleeding from an anomalous ectopic orifice on the right lateral trachea, about 1 cm above the carina. Chest computed tomographic examinations by conventional and spiral methods readily disclosed an ectopic bronchus. Bronchial arteriography showed that the tracheal bronchus was fed by a branched vessel of the thyrocervical artery arising from the brachiocephalic artery. Atypical mycobacterium was detected in bronchoalveolar lavage fluid from the ectopic bronchus. A shunt had formed with the pulmonary artery and peripheral parts of the bronchial artery that fed the tracheal bronchus. It was speculated that the hemoptysis in this case might be due to the combined phenomena of infection and abnormal vessel formation in the tracheal bronchus. In our patient, the system of blood supply to the tracheal bronchus may have been a manifestation of atavism because it closely resembled the circulatory structure of the tracheal bronchi normally observed in sheep and giraffes. The tracheal bronchus should be taken into consideration as a potential cause of hemoptysis, inflammatory changes, and atelectasis during intubation.     

Dieulafoy's disease of the bronchus in association with a paravertebral neurilemoma

Dieulafoy's disease is a vascular anomaly characterized by the presence of a dysplastic artery that is related to an epithelial ulcer. While it is most frequently a GI condition, occurrence in the bronchus has been reported previously in six cases. We present the case of a 51-year-old man with severe hemoptysis and epistaxis. Chest radiographs showed diffuse density in the right base and a mass in the pedicle of T4. The results of bronchoscopy corroborated an active arterial bleeding point in the bronchus of the right middle lobe. A middle and lower lobectomy was performed with resection of the paravertebral mass. The final diagnoses were bronchial Dieulafoy's disease and paravertebral neurilemoma.     

Primary racemose hemangioma of bronchial artery]

A 38-year-old woman was admitted to the hospital because of massive hemoptysis. A chest X-ray film disclosed an infiltrative shadow. A bronchoscopic examination revealed a small, pulsatile, papillary protrusion in the orifice of the middle lobe bronchus, and massive bleeding from the protrusion was observed during the examination. Bronchial arteriography showed convolution and mild hypervascularization of the right bronchial artery. A middle lobectomy was performed, and the protrusion was histologically shown to be a primary racemose hemangioma of the bronchial artery.     

A case of pulmonary actinomycosis with recurrent hemoptysis diagnosed after right upper lobectomy]

The patient was a 58-year-old man who had been admitted in 1995 because of hemoptysis. Chest CT scans showed air-space consolidation with dilated bronchi and calcification in the right S3. He received a diagnosis of bronchiectasis with old tuberculosis. Bronchial arteriography showed arterialization in the right S3, and bronchial artery embolization was performed. But in 1996 hemoptysis reappeared. He was readmitted in May 1999 because of recurrent hemoptysis. Bronchial arteriography showed recurrence of arterialization in the same area, and chest CT scans showed growth of the mass shadow. Right upper lobectomy was performed, and the microscopic findings of the resected specimen showed sulfur granules in the dilated bronchus. We concluded that pulmonary actinomycosis should be considered in the differential diagnosis of abnormal chest shadows.     

隐源性咯血的介入诊断和治疗

目的 探讨隐源性咯血的支气管动脉造影 (BAG)的影像表现与病理机制之间的关系,为其诊断和出血定位寻求可靠依据。方法 1 选择隐源性咯血病人52例,包括以下两种情况：(1)常规影像学检查阴性 (胸部平片、断层阴性,部分病人同期CT及支气管碘油造影阴性) (2)一个肺叶或一侧肺内有少量病变,但BAG证实为非咯血病灶,而另叶或另段肺内有出血征象,计17例。全部病例行Seldinger穿刺技术,导管经主动脉置入双侧支气管动脉造影,确认有造影的直接或间接出血征象,行双重栓塞术。2 另选5例术前影像学检查证实为支气管病变、BAG检查证实为出血部位和出血原因的病例,因栓塞止血无效或其他病变而行手术切除。对5例手术切除标本进行病理镜下检查,分析其与BAG所见的相关性。结果 全部咯血病例,BAG均有不同程度的血管增生紊乱,典型者为扫帚状或网状增生、紊乱的血管束,严重者伴有肺内出血病灶。结合支气管扩张手术标本中的病理所见,如支气管周围支气管动脉的血管数增多、扭曲等,两者的血管改变呈一致性。结论 1 隐源性咯血的病理机制为支气管动脉损伤,而支气管动脉的损伤又为支气管动脉感染所致。故经BAG提示的血管异常改变可以为隐源性咯血的诊断和出血定位提供依据。2 支气管动脉造影和栓塞集诊断与治疗为一体,病人创伤小,且安全有效,在抢救大咯血方面具有实际意义,为控制大咯血提供了一种实用的新途径。     

支气管动脉栓塞治疗肺结核大咯血31例

目的回顾性分析支气管动脉栓塞治疗肺结核合并大咯血。方法对31例肺结核大咯血在影像监视下行选择性支气管动脉造影后用明胶海绵颗粒进行栓塞。结果31例中右侧支气管动脉出血15例,左侧12例,还有4例为两侧支气管动脉共干。结论对肺结核合并大咯血内科保守治疗效果不佳又无条件进行外科手术者,应尽早行支气管动脉造影并栓塞。     

Dieulafoy's disease of the lung: a potential disaster for the bronchoscopist

Dieulafoy's disease of the lung is very rare. We present 2 cases, which are, to our knowledge, the 9th and 10th cases reported in the literature. Haemoptysis is the leading symptom of Dieulafoy's lesion of the lung. In spite of its rareness, the lesion is relevant to the bronchoscopist because a biopsy of the unobtrusive but characteristic bronchial manifestation can precipitate profuse arterial bleeding with a fatal outcome. The bleeding can occur immediately after the biopsy and/or after an interval of up to 12 days. Angiographic images document that this vascular malformation is based on a left-to-right shunt, with a bronchial artery draining into a pulmonary artery. Endobronchial ultrasound may be helpful in detecting the vascular nature of the lesion.     

支气管动脉栓塞治疗支气管扩张大咯血28例

目的回顾性分析支气管动脉栓塞治疗支气管扩张大咯血。方法对28例支气管扩张大咯血患者进行选择性支气管动脉造影，用明胶海绵颗粒等材料进行栓塞。结果左支气管动脉栓塞10例，右支气管动脉栓塞12例，左右支气管动脉共干6例。确定出血血管栓塞后，28例患者咯血停止，27例3日内未再咯血，有1例仍有咯血，1周后再行栓塞术后，咯血停止。结论支气管扩张大咯血进行内科保守治疗效果不佳而又无法耐受外科手术者，应及时行支气管动脉造影并栓塞治疗。