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目的观察咯血患者的食管固有动脉(PEA)血管造影表现,分析出现异常PEA参与供血的高危因素及解剖学基础。资料与方法58例大咯血患者接受螺旋CT及血管造影检查,基础病变包括支气管扩张33例,肺结核20例,肿瘤3例,其他2例。观察选择性PEA插管的结果,分析PEA的血管造影表现及存在异常PEA与病变部位、性质的关系。结果PEA选择性插管成功17例,共发现18支PEA,PEA表现异常7例,血管8支,主要表现为主干增粗、迂曲,分支增多、紊乱并进入相邻下肺组织,PEA与肺动脉分流2例,PEA与正常起源支气管动脉异常交通1例。PEA表现异常者基础病变均为支气管扩张,病灶均累及肺下叶后基底段,病变邻近处纵隔胸膜均无明显增厚粘连。结论当肺内病变累及下叶后基底段时,PEA可通过肺韧带动脉参与咯血的侧支供血。
Objective To observe the angiography results of PEA in patients with hemoptysis and analyze the risk factors and anatomical basis of abnormal PEA involved in blood supply. Materials and Methods 58 cases of hemoptysis underwent spiral CT and angiography. The basic diseases included bronchiectasis in 33 cases, tuberculosis in 20 cases, tumor in 3 cases and the other 2 cases. Observe the results of selective PEA intubation, analysis of angiography of PEA and the existence of abnormal PEA and lesion site, the nature of the relationship. Results Selective cannulation of PEA was successful in 17 cases. Eighteen PEA were found in all, PEA was abnormal in 7 cases and blood vessel in 8 cases. The main features were thickening, tortuous branches, Shunt in 2 cases, PEA and normal origin of bronchial artery abnormal traffic in 1 case. All patients with abnormal PEA showed bronchiectasis. The lesion involved the basal segment of the lower lobe, and there was no obvious thickened adhesions in the mediastinal pleura adjacent to the lesion. CONCLUSIONS: When pulmonary involvement affects the posterior basal segment of the lower lobe, PEA can participate in blood supply to the side branches of hemoptysis through the pulmonary ligament arteries.