锁骨下动脉造影在肺咯血动脉栓塞治疗中的临床意义

目的分析肺咯血患者锁骨下动脉造影征象及临床价值。方法对38例肺咯血患者,在完成了以支气管动脉为主的胸主动脉各分支动脉栓塞治疗后,再进行单侧或双侧锁骨下动脉造影,其中A组:4例为1次以上动脉栓塞治疗后再次行栓塞者(2例行单侧造影,2例行双侧造影),B组:16例结合胸片及胸部CT所示的病变部位行单侧造影(右侧10例、左侧6例),C组:18例双侧造影。判定造影结果分以下3类:正常(-),小分支紊乱、增生(+),明显出血动脉(++)。对造影明确有明显出血血管的部分患者进行栓塞并观察其临床疗效和并发症。结果出血阳性与锁骨下动脉造影人次比为63.2%(24/38)。出血阳性与锁骨下动脉造影血管支数比为50%(29/58),包括(++):37.9%(22/58),(+):12.1%(7/58)。慢性纤维空洞性肺结核患者阳性率最高。阳性出血征象的部位与肺内病变的部位基本一致。对12例强阳性出血征象的患者进行相应动脉栓塞,即刻止血率达100%,符合长期疗效分析的8例患者中,治愈5例,显效1例,复发2例。并发症为发热、恶心呕吐、胸痛、打嗝、呼吸困难。结论锁骨下动脉造影在肺咯血动脉栓塞治疗中有着重要的临床意义,特别是对上肺病变为主的肺咯血患者,其中以慢性纤维空洞性肺结核患者尤为重要。

Clinical significance of subclavian artery angiography in arterial embolization for hemoptysis

Objective To study the subclavian artery angiography for hemoptysis and its clinical value.Methods Thirty-eight cases of hemoptysis undertook subclavian artery angiography after embolization of bronchial arteries and branches of thoracic aorta. Group A: 4 recurrent cases underwent subclavian artery angiography (unilateral: n =2, bilateral: n =2). Group B: 16 cases underwent subclavian artery angiography according to the manifestation on X-ray and CT (right: n =10, left: n =6). Group C: 18 cases underwent bilateral subclavian artery angiography.Results of subclavian artery angiography were divided into three classes: normal(-),chaotic and hyperplasia of small branchi vessels(+),obviously bleeding (++).Some of the obviously bleeding cases were embolized and analysed for clinical efficacy and complications. Results Bleeding cases accounted for 63.2%(24/38)and bleeding subclavian arteries accounted for 50%(29/58), including(++):37.9%(22/58) and(+): 12.1%(7/58). Positive rate of chronic fibro-cavitary pulmonary tuberculosis was the highest. Bleeding sites were coincided with lung lesions. Twelve cases were embolized with the immediate cessation rate of hemoptysis reaching 100%. Eight cases with long-term follow-up showed 5 cured, 1 with significant effect and 2 recurrent. The complications occurred with fever, vomiting, chest pain, hiccup and dyspnoea.Conclusions Subclavian artery angiography has important clinical value in artery embolization for hemoptysis, especially for lesions in the upper lobes of lungs and with more fruitful result for chronic fibro-cavitary pulmonary tuberculosis.