肺结核咯血患者锁骨下动脉造影结果分析

目的研究分析肺结核致咯血患者的锁骨下动脉血管造影表现，评价其在动脉栓塞治疗中的临床价值。方法39例肺结核伴咯血患者中，肺组织严重纤维化或合并空洞、曲菌球、胸膜增厚粘连及胸部手术后25例。在栓塞治疗过程中完成降主动脉各出血分支栓塞术后，根据病变的部位进行锁骨下动脉造影，影像评判标准：正常为（-）；（＋）：锁骨下动脉、腋动脉诸多小分支紊乱、增生，未见其分支明显增粗；（＋＋）：锁骨下动脉、腋动脉的分支明显增粗、扭曲、瘤样扩张，伴肺循环分流等；出血阳性包括（＋）、（＋＋），其中（＋＋）为强阳性。对造影影像学表现进行归纳分析，并根据基础病变程度进行统计学处理。对造影发现为强阳性的部分患者行动脉栓塞术，符合长期疗效分析的15例患者术后作临床疗效评估。结果造影影像学结果显示，出血阳性与造影人次比为32／39，出血强阳性与造影人次比为17／39；出血阳性与造影的锁骨下动脉支数比为39／58，其中（＋＋）为24／58，（＋）为15／58。强阳性出血动脉以胸廓内动脉、胸外侧动脉及肩胛下动脉的出现概率最高。肺组织严重纤维化或合并空洞、曲菌球、胸膜增厚粘连及胸部手术后的患者有明显高的出血阳性率以及强阳性率。15例动脉栓塞术后，治愈6例，显效和有效7例，无效2例。15例中有8例行降主动脉出血分支栓塞后无效，再行动脉栓塞术时，对锁骨下动脉造影发现的出血血管栓塞疗效显著。结论采用动脉栓塞治疗肺结核咯血，应在完成以支气管动脉为主的降主动脉分支栓塞后，如仍有咯血可行相应的锁骨下动脉造影，对肺组织严重纤维化或合并空洞、曲菌球、胸膜增厚粘连、胸部手术后及栓塞术后疗效不佳者，可根据病情同时行锁骨下动脉造影并对其出血血管进行栓塞。

The clinical value and characteristics of subclavian artery angiography for hemoptysis due to pulmonary tuberculosis

Objective To study the signs of subclavian artery angiography for hemoptysis due to pulmonary tuberculosis and to evaluate its clinical use in artery embolization.Methods Thirty-nine patients with hemoptysis due to pulmonary tuberculosis underwent subclavian artery angiography after artery embolization performed in the hemorrhagic branches of descending aorta.Of the 39 cases,25 had severe pulmonary fibrosis or were complicated with cavity formation,aspergilloma,pleural thickening and postoperative thorax.The signs of subclavian artery angiography were divided into three categories:(-),normal;(+),the branches of subclavian artery and axillary artery chaotic and hyperplasia;(++),the branches of subclavian artery and axillary artery appeared tortuosity,dilatation,aneurysm and shunt with pulmonary circulation.Signs of bleeding was designated(+)and(++),with(++)indicating strongly positive.The signs of subclavian artery angiography were studied and statistically analyzed.Artery embolization was performed in some of the patients,among whom 15 were analyzed for long-term clinical curative effect.Results Signs of positive bleeding was found in 32/39 of the cases,and strongly positive bleeding in 17/39 of the cases.Positive bleeding arteries accounted for 39/58 of the branches,including 24/58(++)and 15/58(+).Angiography demonstrated that the internal mammary artery,lateral thoracic artery and subscapular artery were the main hemorrhagic arteries.Patients with severe pulmonary fibrosis or complicated with cavity,aspergilloma,pleural thickening and postoperative thorax showed higher rate of positive and strongly positive bleeding.Artery embolization was performed in 15 cases:cure was achieved in 6,effective in 7 and failure in 2 cases.Of the 15 cases,8 had been ineffective after embolization of the hemorrhagic branches of descending aorta alone.Conclusions Our results suggest that corresponding subclavian artery angiography should be performed after the hemorrhagic branches of descending aorta artery have been embolized for hemoptysis due to pulmonary tuberculosis,especially in cases with failed embolization,or complicated with severe pulmonary fibrosis,cavity formation,aspergilloma,pleural thickening,or postoperative thorax.The hemorrhagic arteries shown by subclavian artery angiography must be embolized.