增强螺旋CT和肺动脉造影在肺动脉栓塞诊断和治疗中的应用

目的 评价螺旋CT和肺动脉造影在肺动脉栓塞诊断和治疗中的作用。方法 回顾性分析经螺旋CT增强和肺动脉造影明确诊断的18例患者的影像资料。其中12例经肺动脉造影后，行导管抽吸和局部溶栓治疗。结果 18例患者累及107处肺动脉及其分支，双肺下叶主支受累最多，达28．97％，累及左、右肺动脉主干者占22．43％，累及肺叶以下分支达40．18％，累及主肺动脉者占8．41％。肺动脉栓塞的影像学直接征象包括部分性充盈缺损、附壁性充盈缺损、中心性充盈缺损（即“轨道征”）、完全阻塞，间接征象包括主肺动脉增宽、局限性肺纹理稀疏、肺梗死和胸腔积液。12例术后临床症状改善，动脉血氧分压增高。结论 螺旋CT增强扫描是一种有效的诊断肺动脉栓塞的无创性检查手段，且诊断率较高。

Clinical application of intensified helical CT and pulmonary artery angiography in diagnosis and treatment of pulmonary embolism

Objective To evaluate the value of helical CT and pulmonary artery angiography in the diagnosis and treatment of pulmonary embolism. Methods The data of helical CT and pulmonary angiography of 18 cases of pulmonary embolism suspected by clinical diagnosis were analyzed retrospectively. Pulmonary embolism was diagnosed in 12 patients with pulmonary angiography, and treated by suction throngh cathether and local fibrinolysis. Results Embolism was found to involve 107 pulmonary artery branches in the 18 cases, including bilateral pulmonary lower lobes in 28. 97%, left and right main pulmonary artery in 22. 43%, lobar artery and segmental artery in 40. 18%, and main pulmonary artery in 8. 41%. The direct signs of helical CT and pulmonary angiography included partial filling defect, mural filling defect, central filling defect or so-called railway-track sign, and total occlusion. Secondary signs included enlargement of pulmonary artery trunk, local pulmonary digernia, pulmonary infarction and pleural effusion. 12 patients survived and showed clinical improvement with significant increase in PaO2. Conclusion Helical CT is a noninvasive and effective method for the diagnosis of pulmonary embolism, while the pulmonary artery angiography is also an important tool in diagnosis and treatment of it.