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探讨隐源性咯血的支气管动脉造影 (BAG)的影像表现与病理机制之间的关系 ,为其诊断和出血定位寻求可靠依据。方法 1 选择隐源性咯血病人 52例 ,包括以下两种情况 :(1)常规影像学检查阴性 (胸部平片、断层阴性 ,部分病人同期CT及支气管碘油造影阴性 ) (2 )一个肺叶或一侧肺内有少量病变 ,但BAG证实为非咯血病灶 ,而另叶或另段肺内有出血征象 ,计 17例。全部病例行Seldinger穿刺技术 ,导管经主动脉置入双侧支气管动脉造影 ,确认有造影的直接或间接出血征象 ,行双重栓塞术。 2 另选 5例术前影像学检查证实为支气管病变、BAG检查证实为出血部位和出血原因的病例 ,因栓塞止血无效或其他病变而行手术切除。对 5例手术切除标本进行病理镜下检查 ,分析其与BAG所见的相关性。结果 全部咯血病例 ,BAG均有不同程度的血管增生紊乱 ,典型者为扫帚状或网状增生、紊乱的血管束 ,严重者伴有肺内出血病灶。结合支气管扩张手术标本中的病理所见 ,如支气管周围支气管动脉的血管数增多、扭曲等 ,两者的血管改变呈一致性。结论 1 隐源性咯血的病理机制为支气管动脉损伤 ,而支气管动脉的损伤又为支气管动脉感染所致。故经BAG提示的血管异常改变可以为隐源性咯血的诊断和出血定位提供依据。 2 支气管动脉造影和栓塞集诊?
To explore the relationship between the imaging manifestations of bronchial arteriography (BAG) and pathological mechanism of cryptogenic hemoptysis, and to seek a reliable basis for the diagnosis and hemorrhage localization. Method 1 Choose 52 patients with cryptogenic hemoptysis, including the following two cases: (1) conventional imaging examination was negative (plain film, negative CT, bronchoscopic and bronchial liposuction in some patients) (2) a lung or Side of the lung a small amount of lesions, but the BAG confirmed non-hemoptysis lesions, while the other leaves or other signs of bleeding in the lungs, accounting for 17 cases. All patients underwent Seldinger puncture technique. The catheter was placed into the bilateral bronchial artery angiography through the aorta to confirm the direct or indirect signs of angiography. Double embolization was performed. 2 The other 5 cases were confirmed as bronchial lesion by preoperative imaging examination. The cases of bleeding and bleeding were confirmed by BAG. Surgical resection was performed due to ineffective embolization or other lesions. Five cases of surgical resection specimens were examined by pathology and analyzed their correlation with BAG. Results All cases of hemoptysis and BAG had different degrees of vascular proliferation disorder, typically broom-like or reticular hyperplasia, vascular disorder, severe cases associated with intra-pulmonary hemorrhage. Combined with the pathological findings in the bronchiectasis specimens, such as bronchial artery around the bronchial vessels increased, distorted, the two vascular changes were consistent. Conclusions 1 The pathological mechanism of cryptogenic hemoptysis is bronchial artery injury, and bronchial artery injury is caused by bronchial artery infection. Therefore, prompted by the BAG vascular abnormalities can change for the diagnosis of cryptogenic hemoptysis and provide the basis for bleeding localization. 2 bronchial arteriography and embolization set diagnosis?