异常体动脉供应正常下肺基底段三例并文献复习

摘要

目的 提高对异常体动脉供应正常下肺基底段临床表现、诊断和治疗的认识.方法 回顾分析宁波大学医学院附属医院、安徽医科大学第二附属医院及山东省金乡县人民医院收治的3例异常体动脉供应正常下肺基底段病例,均为男性,平均年龄36岁,结合文献进行复习.以“anomalous systemic arterial supply to normal lower lobe of the lung"、“anomalous systemic arterial supply to normal basal segments of the lower lobe"和“anomalous systemic arterial supply to normal basal segments of the left lower lobe of the lung”为检索词检索PubMed、Embase及Ovid数据库,以“异常体动脉供应正常肺下叶”、“异常体动脉供应正常下肺基底段”和“异常体动脉供应左肺下叶基底段”为检索词检索万方数据库及中国知网全文数据库,检索时间截止至2017年3月.结果 本组3例患者均以咯血为主要症状就诊,其中1例以大咯血为首发症状.治疗上2例行左肺下叶切除,1例行血管介入栓塞异常体动脉.共检索到26篇相关文献结合本文3例共57例,男女比例为2:1(38:19),平均年龄约35岁.症状以咯血最常见(26/57),其次为无症状(22/57).治疗上主要包括左肺下叶切除术(17/47)和血管介入栓塞异常体动脉(13/47).结论 本病以男性多见,主要症状为咯血,发现咯血患者胸部CT显示左心房后结节或肿块影时,需要对本病提高警惕,胸部增强CT及重建可明确诊断.治疗可根据患者异常体动脉直径大小及症状可选择外科左肺下叶切除术或血管介入栓塞异常体动脉.对于部分无症状患者,可长期随访观察.%Objective To improve the clinical recognition of anomalous systemic arterial supply to normal basal segments of the lower lobe in clinical manifestations,diagnosis and treatment.Methods Three cases were presented and related literatures were reviewed.A literature review was performed with "anomalous systemic arterial supply to normal lower lobe of the lung","anomalous systemic arterial supply to normal basal segments of the lower lobe" and " anomalous systemic arterial supply to normal basal segments of the left lower lobe of the lung" as key words in Pubmed,Embase,Ovid,Wanfang database and CNKI.Result Our 3 cases were male,with an average age of 36 years old;all of them were admitted with hemoptysis.Left lower lobectomy was performed in 2 cases,and the other 1 case underwent endovascular embolization.26 related articles were retrieved and our 3 cases were included in this study with a total of 57 cases.The ratio of male to female was 2:1 (38:19),with an average age of about 35 years old.The most common symptom was hemoptysis (26/57),followed by asymptomatic (22/57).The main treatments included left lower lobectomy (17/47) and endovascular embolization of anomalous systemic artery (13/47).Conclusions This disease is more common in male,and the most common symptom is hemoptysis.When chest CT scan shows a nodular retrocardiac density with hemoptysis symptom,clinicians and radiologists should raise suspicion of anomalous systemic arterial supply to normal basal segments of the lower lobe.Chest contrast-enhanced CT scan is an appropriate imaging method to confirm diagnosis.The main treatments include left lower lobectomy and endovascular embolization.For asymptomatic patient,observation may be an acceptable option.