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目的探讨儿童血管相关性咯血的临床特点及围术期程序性诊治方法。方法回顾性分析16例血管相关性咯血患儿的临床资料及影像学特点,并对其治疗方案及治疗效果进行随访和评价。结果 16例患儿中男4例、女12例,<1岁3例、5~13岁13例。经血管造影明确为主肺侧支循环13例(81.25%)、肺动静脉瘘1例(6.25%)、支气管动脉肺血管瘘1例(6.25%),另1例未明确诊断血管类型。11例患儿行介入封堵治疗,1例行胸腔镜下异常血管结扎术,1例行部分肺叶切除术,3例放弃治疗。11例介入封堵治疗患儿,封堵术后即时造影,2例可见少许分流;3例封堵术1年内咯血复发,均为主动脉侧支循环。2例手术治疗患儿无复发。结论肺血管异常为儿童咯血的主要病因之一,以主肺侧支循环为主要类型,介入封堵仍为儿童血管相关性咯血的一线治疗方案。
Objective To investigate the clinical features of pediatric blood vessel related hemoptysis and its perioperative procedural diagnosis and treatment. Methods The clinical data and imaging features of 16 patients with hemoptysis associated with blood vessels were retrospectively analyzed. The therapeutic regimens and therapeutic effects were followed up and evaluated. Results There were 4 males and 12 females in 16 cases, 3 cases were <1 year old and 13 cases were 5-13 years old. In angiography, 13 cases (81.25%) had pulmonary collateral circulation, 1 pulmonary arteriovenous fistula (6.25%), 1 bronchogenic pulmonary fistula (6.25%), and 1 case without clear diagnosis of vascular type. Eleven cases were treated with occlusion, one case underwent thoracoscopic anomalous vascular ligation, one case underwent partial lobectomy and three cases were given up treatment. Eleven cases were involved in the treatment of occlusion in children, immediately after closure of angiography, 2 cases showed a small shunt; 3 cases of occlusion of hemoptysis recurrence within 1 year, are aortic collateral circulation. Two cases of surgical treatment of children without recurrence. Conclusions Pulmonary vascular abnormalities are one of the major causes of hemoptysis in children. Main collateral circulation is the main type of pulmonary collateral circulation. The first-line treatment of hemoptysis associated with blood vessel involvement in children is still involved.