血管内栓塞术治疗儿童体动脉源性咯血的临床应用

赵趣鸣; 刘芳; 吴琳; 赵璐; 何岚; 陆颖; 王立波

doi:10.7499/j.issn.1008-8830.2018.10.005

PDF(1214 KB)

HTML

中国当代儿科杂志 ›› 2018, Vol. 20 ›› Issue (10) : 809-813. DOI: 10.7499/j.issn.1008-8830.2018.10.005

论著·临床研究

血管内栓塞术治疗儿童体动脉源性咯血的临床应用

赵趣鸣¹, 刘芳¹, 吴琳¹, 赵璐¹, 何岚¹, 陆颖¹, 王立波²

作者信息 +

Clinical effect of endovascular embolization in treatment of hemoptysis of systemic arterial origin in children

ZHAO Qu-Ming¹, LIU Fang¹, WU Lin¹, ZHAO Lu¹, HE Lan¹, LU Ying¹, WANG Li-Bo²

Author information +

文章历史 +

摘要

目的探讨血管内栓塞术（EVE）治疗儿童体动脉源性咯血的临床应用。方法纳入2016年1月至2017年11月进行EVE治疗的20例体动脉源性咯血患儿，分析咯血的栓塞方法和疗效。结果 14例责任血管为支气管动脉（BA），1例为非支气管性体动脉（NBSA），5例为BA和NBSA。13例使用末梢栓塞剂、7例使用弹簧圈进行栓塞，共栓塞责任血管41支（BA 34支，NBSA 7支），均获得即刻止血。2例术后6个月内复发，2例术后6~24个月复发。末梢栓塞剂组的整体复发率（1/13，8%）低于弹簧圈组（3/7，43%），但差异无统计学意义（P=0.10）。1例术后发生颅内异位栓塞，经治疗后目前随访20个月生活质量未受影响；无其他并发症发生。结论 EVE治疗儿童体动脉源性咯血是一种安全有效的方法，值得推广应用。

Abstract

Objective To investigate the clinical effect of endovascular embolization (EVE) in the treatment of hemoptysis of systemic arterial origin in children. Methods A total of 20 children with hemoptysis of systemic arterial origin who underwent EVE from January 2016 to November 2017 were enrolled. The method for embolization was analyzed and the clinical outcome was evaluated. Results Offending vessels were bronchial artery (BA) in 14 children, non-bronchial systemic artery (NBSA) in 1 child, and BA and NBSA in 5 children. Of all the children, 13 underwent EVE with peripheral embolization agents and 7 underwent EVE with mechanical coils. A total of 41 offending vessels were embolized (34 BAs and 7 NBSAs) and all the children achieved immediate arrest of hemoptysis. Two children experienced recurrence within 6 months after EVE and 2 experienced recurrence with 6-24 months after EVE. The peripheral embolization agent group had a lower overall recurrence rate than the mechanical coil group[8% (1/13) vs 43% (3/7); P=0.10]. One child experienced intracranial ectopic embolism after surgery and had good quality of life during 20 months of follow-up after treatment. No other complications were observed. Conclusions EVE is a safe and effective method for the treatment of hemoptysis of systemic arterial origin in children and thus holds promise for clinical application.

导出引用

赵趣鸣, 刘芳, 吴琳, 赵璐, 何岚, 陆颖, 王立波. 血管内栓塞术治疗儿童体动脉源性咯血的临床应用[J]. 中国当代儿科杂志. 2018, 20(10): 809-813 https://doi.org/10.7499/j.issn.1008-8830.2018.10.005

ZHAO Qu-Ming, LIU Fang, WU Lin, ZHAO Lu, HE Lan, LU Ying, WANG Li-Bo. Clinical effect of endovascular embolization in treatment of hemoptysis of systemic arterial origin in children[J]. Chinese Journal of Contemporary Pediatrics. 2018, 20(10): 809-813 https://doi.org/10.7499/j.issn.1008-8830.2018.10.005

参考文献

[1] Simon DR, Aronoff SC, Del Vecchio MT. Etiologies of hemoptysis in children:a systematic review of 171 patients[J]. Pediatr Pulmonol, 2017, 52(2):255-259.
[2] Ramírez Mejía AR, Méndez Montero JV, Vásquez-Caicedo ML, et al. Radiological evaluation and endovascular treatment of hemoptysis[J]. Curr Probl Diagn Radiol, 2016, 45(3):215-224.
[3] Dokumcu Z, Ozcan C, Alper H, et al. Pulmonary arteriovenous malformation in children[J]. Pediatr Int, 2015, 57(4):708-711.
[4] Abdulhamid I, Forbes T. Severe hemoptysis from dilated systemic aberrant arteries supplying normal lung segments[J]. Pediatr Pulmonol, 2004, 38(6):477-482.
[5] Nugent Z, Oliveira V, Maclusky I, et al. Bronchial arterypulmonary artery malformation as a cause of cryptogenic hemoptysis[J]. Pediatr Pulmonol, 2013, 48(9):930-933.
[6] Sismanlar T, Aslan AT, Akkan K, et al. Successful embolization in childhood hemoptysis due to abnormal systemic arterial bleeding of the lung and review of the literature[J]. Clin Respir J, 2016, 10(6):693-697.
[7] 况虹宇, 程真莉, 罗历, 等. 儿童血管相关性咯血介入治疗的临床评价[J]. 临床儿科杂志, 2017, 35(1):19-23.
[8] 刘帆, 刘新献, 李亮, 等. 经支气管动脉介入治疗儿童咯血的临床疗效研究[J]. 介入放射学杂志, 2012, 21(11):945-948.
[9] Khalil A, Fedida B, Parrot A, et al. Severe hemoptysis:from diagnosis to embolization[J]. Diagn Interv Imaging, 2015, 96(7-8):775-788.
[10] 陈和斌, 陆小霞, 蒋鲲. 儿童反复咯血的病因及临床诊治分析[J]. 中国当代儿科杂志, 2014, 16(3):281-284.
[11] 吴春雪, 陈强. 儿童咯血治疗进展[J]. 中国实用儿科杂志, 2015, 30(6):461-465.
[12] Singh D, Bhalla AS, Veedu PT, et al. Imaging evaluation of hemoptysis in children[J]. World J Clin Pediatr, 2013, 2(4):54-64.
[13] 叶丽芳, 伍筱梅. 体-肺循环分流的病理-影像学研究[J]. 中华介入放射学电子杂志, 2014, 2(1):63-65.
[14] Walker CM, Rosado-de-Christenson ML, Martínez-Jiménez S, et al. Bronchial arteries:anatomy, function, hypertrophy, and anomalies[J]. Radiographics, 2015, 35(1):32-49.
[15] Leyon JJ, Littlehales T, Rangarajan B, et al. Endovascular embolization:review of currently available embolization agents[J]. Curr Probl Diagn Radiol, 2014, 43(1):35-53.
[16] Ittrich H, Klose H, Adam G. Radiologic management of haemoptysis:diagnostic and interventional bronchial arterial embolisation[J]. Rofo, 2015, 187(4):248-259.
[17] 杨帆, 何杰, 代文静, 等. 支气管动脉栓塞术治疗支气管扩张大咯血的临床疗效评价[J]. 中华肺部疾病杂志(电子版), 2016, 9(3):311-312.
[18] Antonelli M, Midulla F, Tancredi G, et al. Bronchial artery embolization for the management of nonmassive hemoptysis in cystic fibrosis[J]. Chest, 2002, 121(3):796-801.
[19] Barben J, Robertson D, Olinsky A, et al. Bronchial artery embolization for hemoptysis in young patients with cystic fibrosis[J]. Radiology, 2002, 224(1):124-130.
[20] Wang GR, Ensor JE, Gupta S, et al. Bronchial artery embolization for the management of hemoptysis in oncology patients:utility and prognostic factors[J]. J Vasc Interv Radiol, 2009, 20(6):722-729.
[21] Laborda A, Tejero C, Fredes A, et al. Posterior circulation stroke after bronchial artery embolization. A rare but serious complication[J]. Cardiovasc Intervent Radiol, 2013, 36(3):860-863.
[22] Park JH, Kim DS, Kwon JS, et al. Posterior circulation stroke after bronchial artery embolization[J]. Neurol Sci, 2012, 33(4):923-926.
[23] Fruchter O, Schneer S, Rusanov V, et al. Bronchial artery embolization for massive hemoptysis:long-term follow-up[J]. Asian Cardiovasc Thorac Ann, 2015, 23(1):55-60.