43例儿童肺血管畸形咯血的临床分析

Clinical Analysis of Hemoptysis in 43 Children with Pulmonary Vascular Malformation

摘要: 目的：探讨儿童肺血管畸形所致咯血的临床特点及诊治方法。方法：回顾性分析重庆医科大学附属儿童医院收治的43例肺血管畸形咯血患儿的临床表现、实验室检查、影像学资料及治疗转归。结果：1)本组患儿以大龄儿童为主，且多伴随呼吸道症状；2)心脏彩超及胸片可作为初筛手段，CTA和DSA对肺血管畸形检出率高，分别为97.6%、100%，支气管镜及DSA兼具检查与治疗作用。3)介入封堵是首选治疗手段，封堵困难者需外科干预，长期随访多数预后良好。4)治疗方式选择与咯血量无明显相关。结论：怀疑肺血管畸形所致咯血患儿应尽早行CTA确诊，介入封堵是首选治疗手段。

Abstract: Objective: To discuss the clinical features, diagnosis and treatment of hemoptysis caused by pul-monary vascular malformations in children. Methods: Retrospective analysis method was used to analyze the clinical features, laboratory tests, imaging data and treatment outcomes of 43 cases of hemoptysis with pulmonary vascular malformation that admitted to Children’s Hospital of Chong-qing Medical University. Results: 1) The children were mainly older child, and most of them were accompanied by respiratory symptoms. 2) Color doppler echocardiography and chest radiograph can be used as preliminary screening methods. CTA and DSA had a high detection rate of pulmonary vascular malformations, which were 97.6% and 100% respectively. Bronchoscopy and DSA had both examination and treatment effects. 3) Interventional occlusion was the first choice of treat-ment, surgical intervention was required for the difficult occlusion. Most patients had good progno-sis after long-term follow-up. 4) There was no significant correlation between the choice of treat-ment methods and the amount of hemoptysis. Conclusions: Children suspected of hemoptysis caused by pulmonary vascular malformation should be diagnosed by CTA as soon as possible, and interventional occlusion is the first treatment.