Zhang Jiyan,Liu Teng,Xiao Zhenghui,et al.Clinical analysis and interventional assessment of bronchial pulmonary artery fistula in children: a report of 20 cases[J].Journal of Clinical Pediatric Surgery,2024,(11):1077-1081.[doi:10.3760/cma.j.cn101785-202403024-014]
儿童支气管动脉肺动脉瘘的临床特征及介入手术疗效分析
- Title:
- Clinical analysis and interventional assessment of bronchial pulmonary artery fistula in children: a report of 20 cases
- Keywords:
- Bronchial Arteries; Hemoptysis; Interventional; Child
- 摘要:
- 目的 初步探讨儿童先天性支气管动脉肺动脉瘘的临床特点以及介入手术治疗效果。方法 回顾性分析2016年1月至 2023年8月湖南省儿童医院采取介入手术治疗的20例支气管动脉肺动脉瘘患儿临床资料,收集并分析患儿临床表现、实验室和影像学检查资料以及介入手术治疗结果。结果 20例患儿中,17例表现为咯血,其中少量咯血4例、中量咯血5例、大量咯血8例;3例无咯血患儿中,1例表现为呕血,1例表现为呼吸困难,1例以胸壁肿物就诊(最终诊断为卡波西型血管瘤)。11例伴有不同程度贫血,其中轻度贫血3例、中度贫血7例、重度贫血1例。20例均行胸部增强CT检查,其中5例发现增粗、迂曲的支气管动脉。出血部位:右肺上叶1例,右肺中叶4例,右肺下叶7例,右肺中下叶混合2例,左肺下叶1例,双肺2例,3例未见明显出血病灶。20例均行数字减影血管造影(digital subtraction angiography,DSA),确诊为右侧支气管动脉肺动脉瘘19例,左侧支气管动脉肺动脉瘘1例。20例均予介入手术治疗,其中16例行首次介入治疗后随访1~4年,无一例复发,治疗效果满意;4例首次介入治疗后复发,其中3例为复发1次后行再次介入手术治疗未再复发,1例为复发5次后行第3次介入手术治疗,末次手术至今已3年6个月,暂未复发。结论 咯血是支气管动脉肺动脉瘘的主要临床表现,胸部增强CT和DSA检查有助于诊断支气管动脉肺动脉瘘;介入手术疗效确切,但有一定的复发率。
- Abstract:
- Objective To summarize the clinical characteristics of bronchial pulmonary artery fistula (BPAF) and evaluate the efficacy of interventional closure. Methods For this retrospective case study,20 children were diagnosed with bronchial pulmonary artery fistula at Hunan Children’s Hospital from January 2016 to August 2023.Clinical symptoms and enhanced chest computed tomography (CT) findings were recorded.Efficacy and postoperative recurrence were evaluated. Results The symptoms of hemoptysis occurred (n=17),including mild hemoptysis (n=4),moderate hemoptysis (n=5) and massive hemoptysis (n=8).Among 3 cases of non-hemoptysis,there were hematemesis (n=1),dyspnea (n=1) and Kaposi type hemangioma with "chest wall mass" (n=1).Eleven cases had varying degrees of anemia,including mild anemia (n=3),moderate anemia (n=7) and severe anemia (n=1).Enhanced chest CT revealed thickened and tortuous bronchial arteries (n=5).Digital subtraction angiography (DSA) was performed for confirming the diagnosis of right bronchial arterio-pulmonary fistula (n=19) and left bronchial arterio-pulmonary fistula (n=1).Hemorrhagic lesions were located in right upper lobe (n=1),right middle lobe (n=4) and right lower lobe (n=7),mixed right middle/lower lobe (n=2),left lower lobe (n=1) and bilateral lungs (n=2).Sixteen cases received initial interventions.During a follow-up period of 1 to 4 years,there was no recurrence.The outcomes were satisfactory; Four cases recurred after initial interventions,3 cases relapsed once and 1 case relapsing 5 times was treated thrice.The last operation was 42 months ago.There was no recurrence. Conclusions Hemoptysis is a major clinical manifestation of BPAF.Enhanced chest CT is conducive to making a definite diagnosis and DSA is a gold standard of diagnosis.Interventional therapy is both safe and effective and it has a definite efficacy with a certain recurrence rate.
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备注/Memo
收稿日期:2024-3-14。
基金项目:儿童急救医学湖南省重点实验室(2018TP1028);湖南省卫生健康委科研计划课题(202206013971)
通讯作者:段效军,Email:dxj801010@126.com