Objective: To summarize the clinical characteristics of bronchial-pulmonary artery fistula and evaluate the effect of interventional closure of bronchial-pulmonary artery fistula. Methods: A retrospective case study was conducted. Fifteen children with hemoptysis who were diagnosed with bronchial-pulmonary artery fistula in Beijing Children's Hospital, Capital Medical University from January 2018 to March 2022 were selected. Their clinical symptoms and chest-enhanced CT findings were recorded. The children who failed to improve after anti-infection and hemostasis treatment were treated with transcatheter embolization through microparticles under digital subtraction angiography (DSA). The efficacy and post-operation recurrence were evaluated. Results: There were 15 children, including 9 males and 6 females, aged 9.8 (3.7, 12.1) years, weighing 35 (16, 55) kg. There was hemoptysis of varying degrees before surgery. Only 2 children had decreased hemoglobin. Chest enhanced CT showed that their bronchial arteries were thickened and tortuous, including 11 cases of single vessel disease and 4 cases of multivessel disease; 11 children had varying degrees of pneumonia and 4 children had atelectasis. Except for one case effectively treated with medical therapy, the remaining 14 cases were all treated with transcatheter interventional closure with embolic microparticles, among whom 12 had their fistula completely blocked with a single operation and the other 2 children underwent multiple operations because of too many fistulas. One child had extensive bronchial-pulmonary artery fistula which failed to be blocked completely even after multiple operations. Among the remaining 13 children, only 2 patients whose fistula was considered to be completely closed had recurrence presenting with hemoptysis at 3 months and 2 years after the operation, and no hemoptysis was found after the second closure. All children were discharged without chest pain, spinal cord paraplegia, or other serious complications. Fourteen children were followed up for 1.4 (0.9,2.9) years, among whom one still has intermittent mild hemoptysis due to incomplete closure and the rest had a satisfactory outcome. Conclusions: Hemoptysis is the first symptom of bronchial-pulmonary artery fistula. For children with failed medical treatment, transcatheter closure with an embolic pellet is effective, safe and feasible, with a low recurrence rate.
目的： 总结支气管动脉肺动脉瘘的临床特点，评价支气管动脉肺动脉瘘介入封堵手术的效果。 方法： 回顾性病例总结。以2018年1月至2022年3月在首都医科大学附属北京儿童医院因咯血就诊，并诊断为支气管动脉肺动脉瘘的15例患儿为研究对象，记录患儿临床症状及胸部增强CT表现，经内科抗感染及止血治疗无效的患儿在数字减影血管造影（DSA）下经导管应用栓塞微粒球介入封堵治疗，评价封堵效果及随诊复发情况。 结果： 15例患儿中男9例、女6例，年龄9.8（3.7，12.1）岁，体重35（16，55）kg，术前均有不同程度的咯血，仅2例患儿有血红蛋白下降，胸部增强CT显示患儿支气管动脉可见增粗迂曲，其中单支病变11例，多支病变4例，11例患儿有不同程度肺炎表现，4例患儿出现肺不张，除1例内科治疗有效外，余14例均应用栓塞微粒球经导管介入封堵治疗，12例患儿经单次手术完全封堵所有瘘管，2例患儿因瘘管过多，单次手术难以根治，采用分次封堵，其中1例广泛支气管动脉肺动脉瘘患儿，多次手术仍未封堵完全。其余13例患儿中仅有2例在术中判定完全封堵后，分别于术后3个月及2年再次出现咯血症状，行二次封堵后未再咯血，术后患儿均未见胸痛及脊髓截瘫等严重并发症。14例介入封堵手术的患儿随访1.4（0.9，2.9）年，1例患儿未能完全封堵，仍间断少量咯血，余患儿治疗效果均满意。 结论： 支气管动脉肺动脉瘘多以咯血为首发症状，对内科治疗无效的患儿，应用栓塞微粒球经导管介入封堵治疗效果良好，复发率低且安全、可行。.