经导管动脉栓塞术治疗全身肺动脉分流,随后进行肺段切除术

Hirotsugu Notsuda, Fumiko Tomiyama, Ken Onodera, Tatsuaki Watanabe, Yui Watanabe, Hisashi Oishi, Hiromichi Niikawa, Chihiro Inoue, Hideki Ota, Masafumi Noda, Yoshinori Okada
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摘要

全身-肺动脉分流(SPAS)是一种罕见的疾病,可因先天性心脏病或慢性肺部炎症而发生,偶尔会导致危及生命的咯血。计算机断层扫描(CT)成像是诊断 SPAS 的关键,而 SPAS 的最佳治疗方法仍不确定。本病例报告介绍了一种治疗 SPAS 的新方法,即经导管动脉栓塞系统动脉,然后进行肺段切除术。一名 42 岁的男子因胸部检查结果异常转诊至我院,CT 结果显示扩张的左侧第 4 肋间动脉血流倒流至中轴 A6,因此确诊为 SPAS。患者没有任何症状,但我们决定对他进行治疗,以防止未来发生咯血的风险。经导管动脉栓塞术(TAE)对全身动脉进行栓塞,然后进行S6段切除术,手术成功,失血量极少,并完全切除了扩张的肺内血管。组织学分析证实了 SPAS 的诊断。我们报告了一例 SPAS 病例,该患者成功接受了 TAE 和随后的肺段切除术。手术中的失血量极少,而且这种策略似乎能最大限度地减少未来的再狭窄和咯血。我们需要对 SPAS 患者进行进一步研究和长期随访,以便为这种罕见病制定标准化的治疗指南。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Systemic-to-pulmonary artery shunt treated with transcatheter arterial embolization and subsequent lung segmentectomy
Systemic-to-pulmonary artery shunt (SPAS) is a rare condition that can occur as a result of congenital heart disease or chronic pulmonary inflammation, occasionally leading to life-threatening hemoptysis. Computed tomography (CT) imaging is crucial in the diagnosis of SPAS, and the optimal management approach for SPAS remains uncertain. This case report presents a novel approach to the treatment of SPAS, consisting of transcatheter arterial embolization of the systemic artery followed by lung segmentectomy. A 42-year-old man with abnormal chest findings was referred to us and a diagnosis of SPAS was established based on the CT findings showing a blood flow regurgitation from the dilated left 4th intercostal artery to the Lt. A6. The patient was asymptomatic but we decided to treat him to prevent a risk of future hemoptysis. Transcatheter arterial embolization (TAE) of systemic arteries followed by S6 segmentectomy was successfully performed with minimal blood loss and complete removal of the dilated intra-pulmonary blood vessels. Histological analysis confirmed the diagnosis of SPAS. We reported a case of SPAS, who was successfully treated with the combination of TAE and subsequent segmentectomy. The blood loss during surgery was minimal and this strategy appeared to minimize future recanalization and hemoptysis. Further studies and long-term follow-up of SPAS patients are required to establish standardized management guidelines for this rare condition.
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