支气管Dieulafoy病的诊断与治疗

Diagnosis and treatment of Dieulafoy’s disease of the bronchus

摘要:

目的 探讨支气管Dieulafoy病的临床表现、诊断及治疗，以提高对该病的认识。 方法 回顾性分析6例支气管Dieulafoy病的临床表现、支气管镜下病变特点、诊断方法及治疗。 结果 临床表现5例为咯血，1例为胸痛。支气管镜下5例见管腔内光滑突起病灶，1例见黏膜下血管扭曲分布。5例经支气管镜及支气管动脉造影诊断，1例经支气管动脉造影和术后病理诊断。4例行支气管动脉栓塞术，其中1例栓塞后行肺叶切除术，1例在支气管动脉造影下以立止血注入畸形支气管动脉，1例内科止血治疗。 结论 对于不明原因咯血和（或）支气管镜下见到管腔内光滑突起时，应考虑支气管Dieulafoy病可能，支气管镜下谨慎活检。及时行支气管动脉造影可诊断。支气管动脉栓塞和外科手术是治疗的主要方法，肺叶切除术可根治。

Abstract:

【Objective】 To explore the clinical manifestations, diagnosis and treatment of Dieulafoy's disease, in order to raise awareness of this disease. 【Methods】 6 cases of bronchial Dieulafoy's disease were retrospectively analyzed on the clinical manifestation,diagnosis and treatment under bronchoscope . 【Results】 Clinical manifestations included hemoptysis (5 cases), pectoralgia (1 case). Changes under bronchoscope, 5 cases with smooth protuberance within the lumen, 1 case with submucosal vessels distortion distribution. 5 cases diagnosed by bronchoscopy and bronchial arteriography, 1 case diagnosed by bronchial arteriography and postoperative pathological diagnosis. In treatment of Dieulafoy's disease, 4 cases of bronchial artery embolization, one case received lobectomy after embolism; One case was treated by injecting reptilase into abnormal arteriae bronchiales under bronchial arteriography; one case of internal hemostatic treatment. 【Conclusion】 For patients with unexplained hemoptysis and/or smooth protuberance within the lumen by bronchoscopy, bronchial Dieulafoy disease should be considered，at this time, bronchoscopy biopsy should be cautious. Dieulafoy's disease can be diagnosed by bronchial arteriography. Bronchial artery embolization and surgery are the main method of treating Dieulafoy's disease. Lobectomy can cure.