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目的观察咯血患者的异常肺韧带动脉血管造影表现,探讨异常肺韧带动脉参与咯血的高危因素。方法回顾性分析2005年1月至2011年12月间75例行支气管动脉栓塞(BAE)的大咯血患者的临床资料。所有患者术前均接受胸部CT平扫或增强扫描。观察异常肺韧带动脉的血管造影表现,分析肺韧带动脉参与咯血与病变部位、性质及纵隔胸膜受累的关系。结果 6例患者基础病变累及下肺后基底段,均无明显纵隔胸膜增厚及粘连,其中1例病变累及横膈胸膜及侧壁胸膜。此6例患者中,5例(支气管扩张)可见异常增粗、迂曲的肺韧带动脉参与供血病变肺实质,1例未见肺韧带动脉参与供血。5例肺韧带动脉参与咯血者经支气管动脉及肺韧带动脉栓塞后随访12个月未见咯血复发,其中1例病变累及侧壁胸膜及横膈胸膜者同时栓塞了参与供血的2支肋间动脉及膈下动脉。其他部位肺部病变未累及下肺后基底段者均未见肺韧带动脉参与咯血。结论当基础病变累及肺下叶后基底段时,尽管无纵隔胸膜受累,肺韧带动脉可成为咯血的重要出血来源。
Objective To investigate the manifestations of abnormal pulmonary ligament angiography in patients with hemoptysis and to explore the risk factors for the involvement of abnormal pulmonary ligament arteries in hemoptysis. Methods The clinical data of 75 patients with massive hemoptysis undergoing bronchial artery embolization (BAE) from January 2005 to December 2011 were retrospectively analyzed. All patients underwent preoperative CT chest scan or enhanced scan. To observe the angiographic findings of abnormal pulmonary ligament arteries and to analyze the relationship between pulmonary ligament arteries involved in hemoptysis and the location of the lesion, nature and mediastinal pleura involvement. Results Six patients with underlying lesions involving the posterior segment of the posterior segment of the lung had no significant mediastinal pleural thickening and adhesions. One of the lesions involved the diaphragmatic pleura and lateral pleura. Among the 6 patients, 5 cases (bronchiectasis) showed abnormal thickening, tortuous pulmonary ligament arteries involved in pulmonary parenchymal lesions, and 1 case without pulmonary ligament artery involved in blood supply. 5 cases of pulmonary ligament artery involved in hemoptysis by bronchial artery and pulmonary ligament artery embolization were followed up for 12 months did not see the recurrence of hemoptysis, including 1 case of lesions involving the lateral pleural and diaphragm pleurisy also embolization of two intercostal arteries involved in blood supply And subphrenic artery. Other parts of the lung lesions did not involve the lower posterior basement pulmonary ligament were not involved in hemoptysis. CONCLUSIONS: Pulmonary ligament arteries can be a significant source of hemoptysis when underlying lesions affect the basal segment of the lower lobe, despite involvement of the mediastinal pleura.