摘要
目的探讨儿童先天性肺动静脉畸形的临床特点,评估CT血管成像(CTA)和数字减影血管造影(DSA术在其诊断中的价值。方法回顾性分析2015年4月至2020年5月南京医科大学附属儿童医院收治的7例先天性肺动静脉畸形患儿的临床特征、实验室检查、影像学资料及治疗转归。结果(1)肺动静脉瘘4例:以紫绀及杵状指为主要表现,CTA均提示肺动静脉畸形。1例手术切除右下肺;2例于胸腔镜下对累及肺动静脉瘘结扎;1例通过DSA对右下动静脉瘘处封堵栓塞。1例尚住院治疗,3例随访1~5年紫绀及杵状指明显改善。(2)支气管动脉-肺动脉瘘3例,均以咯血为主要表现。2例行CTA检查,其中1例提示右肺支气管动脉增粗迂曲,1例未发现异常支气管动脉;3例均行DSA术,术中均见异常支气管动脉分支显影及分流,2例予以支气管动脉封堵栓塞治疗,其中1例封堵2个月后又出现咯血,再次行封堵,随访3年无咯血,另有1例因分流较小,予临床观察,随访15个月无咯血。结论不明原因咯血、紫绀、杵状指的患儿需考虑先天性肺动静脉畸形,CTA或DSA检查有利于明确诊断,DSA检查较CTA更能直观地观察到受累血管及其走行,并能对受累的血管范围及其复杂程度进行判断。
Objective To explore the clinical features of congenital pulmonary arteriovenous malformations in children,and evaluate the role of CT angiography(CTA)and digital subtraction angiography(DSA)in the diagnosis.Methods Retrospectiveanalysismethodwas usedtoanalyzetheclinical features,laboratory tests,imaging data and treatment outcomes of seven cases of congenital pulmonary arteriovenous malformation admitted to Children’s Hospital of Nanjing Medical University.Results(1)Four cases were pulmonary arteriovenous fistula with the main clinical symptom of cyanosis and clubbed fingers,and were shown to be pulmonary arteriovenous malformations by CT angiography(CTA).One case received surgical resection of the right lower lung.Two cases received thoracoscopic ligation surgery for the involved pulmonary arteriovenous fistula.One case underwent occluded embolization surgery for the right lower arteriovenous fistula under DSA.The cyanosis and clubbed fingers were significantly improved after 1-5 years’clinical follow-up in three cases.One case still stayed in the hospital for treatment.(2)Three cases were bronchial artery-pulmonary arterial fistula with clinical manifestation of hemoptysis.According to the CT angiography(CTA)imaging of two cases,one case was thickened and tortuous right bronchial artery,and the other case had no abnormal bronchial artery.DSA surgery was performed in all three patients.Abnormal bronchial artery branch development and shunt were observed during the surgery.Two cases received occluded embolization treatment for the bronchial artery.One case had hemoptysis again two months after the occluded embolization treatment,and was occluded again.The 3-year follow-up showed no hemoptysis after that.One case was clinically observed due to small shunt and was followed up for about 15 months,which showed nohemoptysis.Conclusion Children with unexplained hemoptysis,cyanosis and clubbed fingers should be considered as with congenital pulmonary arteriovenous malformations;CTA or digital subtraction angiography is helpful to make a definite diagnosis.Compared with CTA,DSA shows the involved blood vessels and their movement more directly,and helps to judge the range and complexity of the involved vessels.
作者
张书兰
田曼
包玉玲
武开宏
陈金龙
姚琼
ZHANG Shu-lan;TIAN Man;BAO Yu-ling(Respiration Department,Children’s Hospital of Nanjing Medical Uni⁃versity,Nanjing 210000,China)
出处
《中国实用儿科杂志》
CSCD
北大核心
2020年第9期717-721,共5页
Chinese Journal of Practical Pediatrics
关键词
儿童
肺动静脉瘘
支气管动脉-肺动脉瘘
child
pulmonary arteriovenous malformation
bronchial artery-pulmonary artery fistula
作者简介
通讯作者:田曼,电子信箱:tmsweet@163.com
