经导管介入治疗肺动静脉瘘5例诊治体会

目的探讨经导管介入治疗肺动静脉瘘（PAVF）的疗效与并发症的预防方法。方法选择5例PAVF患者临床资料进行回顾性分析,其中男性2例,女性3例;年龄5~41岁,平均年龄12.64岁。应用弹簧圈、国产动脉导管未闭（PDA）封堵器和外科胶行经导管介入封堵治疗。结果 2例患者应用弹簧圈封堵,1例患者应用PDA封堵器封堵,1例患者应用外科胶栓塞成功,术后股动脉血氧饱和度显著升高。1例患者为弥漫型细小PAVF,未进行封堵。1例术后有一过性左侧肢体无力,诊断为轻微脑栓塞,给予抗凝治疗,20 h后肌力恢复正常。随访10个月到8年,1例弥漫性PAVF患者确诊3年后死于大咯血,其余4例均无再通及封堵器脱落、移位等并发症。结论经导管介入封堵治疗PAVF安全有效,操作简单,创伤小,恢复快,可最大限度地保留正常肺组织及其功能,规范操作可预防并发症的发生。

Treatment experience of transcatheter closure for pulmonary arteriovenous fistula in 5 cases

Objective To explore the curative effect of transcatheter closure of pulmonary arteriovenous fistula（PAVF） and methods of preventing complications.Methods A total of 5 patients with PAVF were analyzed retrospectively,included 2 males and 3 females,who were 5-41 years old with a mean age of 12.64.The transcatheter closure of PAVF were performed with coil device,home-made patent ductus arteriosus occluder and surgical adhesive.Results Two cases were occluded with coil device,1 case was occluded with home-made patent ductus arteriosus occluder,1 case was occluded with surgical adhesive,the femoral artery blood oxygen saturation increased significantly.One case with diffuse tiny PAVF was not treated.One case had transient left limb weakness,which was diagnosed as mild cerebral embolism,and the muscle strength returned to normal after 20-hour anticoagulation therapy.All the cases were followed up 10-month to 8-year,1 case with diffuse tiny PAVF died of massive hemoptysis after 3-year,and there was no recanalization,shedding and migration occurred in the other 4 cases.Conclusion It is demonstrated that transcatheter closure of PAVF is a safe and effective method,with the advantages of simple operation,less trauma and quicker recovery,it could maximize the retention of lung tissues and function,the standard operation could prevent complications.