甲状颈干栓塞术在外周血管介入中的临床意义

doi:10.3877/cma.j.issn.2095-5782.2015.02.005

目的

观察甲状颈干参与肿瘤及咯血供血的表现，评价栓塞甲状颈干的安全性和疗效。

方法

2年间用介入技术治疗外周疾病（肿瘤及咯血）术中经血管造影证实甲状颈干参与病变咯血供血13例，其中纵隔肿瘤2例、肺部咯血性疾病11例，包括：肺部恶性肿瘤3例、支气管扩张6例、肺结核2例。年龄25～69岁,平均年龄44.5岁。对参与供血的甲状颈干进行了超选择性栓塞术，栓塞剂用聚乙烯醇微球（PVA，500～700μm）、明胶海绵颗粒和微型钢丝圈。观察甲状颈干参与病变供血的特点，评价栓塞甲状颈干的安全性和临床意义。

结果

选择性造影均显示甲状颈干管径增粗、分支增多紊乱和不同程度的新生血管形成，伴有肿瘤血管和肿瘤染色者5例次、咯血患者中由甲状颈干供血区对比剂外溢4例次、非特异性片状对比剂染色4例。本组患者均行供血甲状颈干的栓塞术，同时栓塞胸廓内动脉9例、肋间动脉8例、膈下动脉3例、支气管动脉7例，术后咯血停止；随访2个月～2年，11例未再咯血。纵隔肿瘤患者介入治疗后行外科切除，术中出血仅100 ml。

结论

甲状颈干可参与纵隔肿瘤及咯血的供血，如发现甲状颈干参与纵隔肿瘤及咯血供血，补充栓塞甲状颈干安全有效。

关键词: 咯血, 支气管，动脉, 甲状颈干, 血管造影术, 栓塞，治疗性

Objective

To describe the manifestations of thyrocervical trunk blood supply in hemoptysis or tumor and to evaluate the safety and efficacy of transcatheter arterial embolization (TAE) of the thyrocervical trunk.

Methods

During the past 2 years, 13 patients with hemoptysis and malignant tumor underwent BAE. Mean patient age was 44.5 years (range, 25—69 years). Supplemental TAE using PVA particles, gelatin sponge particles and microcoils was undertaken in the thyrocervical trunk supplying cases. The imaging findings of the thyrocervical trunk angiography, the predictive factors, the technique and clinical significance, including safety of the thyrocervical trunk embolization, were evaluated.

Results

Selective arteriogram demonstrated enlargement of the thyrocervical trunk, with numerous branches and neovsaculature in all 13 cases, including contrast material extravasation in 4, tumor staining in 5, and non-specific staining in 4 cases. Technical success of thyrocervical trunk embolization was achieved in all 13cases. Embolization of other nonbronchial systemic arteries (the internal thoracic artery in 9、intercostal artery in 8 and inferior phrenic artery in 3 cases) and bronchial artery in 7 cases were performed at the same session. All bleedings ceased immediately after supplemental thyrocervical trunk embolization. Follow-up ranged from 2 months to 2 years, no recurrent bleeding in 11 patients. The patients with mediastinal mass received resection after embolization.

Conclusions

Thyrocervical trunk may be a supplemental artery for hemoptysis and mediastinal mass, resulting in clinical failure of BAE and supplemental TAE of thyrocervical trunk is a safe and effective adjunct to BAE in the management.

Key words: Hemoptysis, Arteries, bronchial, thyrocervical trunk, Angiography, Embolization, therapeutic

图1 患者女性，41岁，支气管扩张伴咯血，外院支气管动脉栓塞术后仍咯血不止。肺CT显示：右肺中叶不张实变，下叶多发磨玻璃影（图A,→）。选择性右侧甲状颈干造影显示：右侧甲状颈干管径明显增粗，走行迂曲，发出分支参与右肺中下叶供血，可见造影剂外溢表现(图B、图C，→）。经补充栓塞该支血管后，咯血停止

图2 患者男性，68岁，肺结核合并咯血，首次介入治疗后2月，再发大咯血。支气管动脉造影显示：右侧支气管动脉主干闭塞，右侧可见细小分支显影（图A,→）。右侧甲状颈干造影显示其明显增产、走行迂曲，发出分支参与右支气管、右下肺供血（图B,→）。左侧膈下动脉、右侧胸括内动脉明显增粗、发出分支参与肺内病灶供血（图C、图D,→）。经栓塞上述血管后，咯血停止

图3 患者男性，71岁，右肺中叶鳞癌伴间断咯血，急诊行介入检查和治疗。支气管动脉造影显示：左右支气管动脉共干，右侧支气管动脉参与肿瘤供血（图A,→）。右侧甲状颈干造影显示：右侧甲状颈干管径增粗，走行迂曲，发出分支参与肺内肿瘤供血。经急诊栓塞止血后出血停止（图B,→）

图4 患者男性，56岁，纵隔神经纤维瘤，术前栓塞。纵隔CT示：病变位于右肺上后段。（图A,→）。锁骨下动脉造影显示：右侧纵隔肿瘤显影。超选择性甲状颈干造影显示：动脉晚期染色

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Clinical significance of supplemental transcatheter arterial embolization of thyrocervical trunk in the interventional procedure for peripheral disease

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Clinical significance of supplemental transcatheter arterial embolization of thyrocervical trunk in the interventional procedure for peripheral disease