- 期刊
- OpenAccess
Left Main Bronchus as an Anatomical Landmark in Bronchial Angiography
左側主支氣管：一個支氣管動脈攝影術的解剖學參考指標
摘要
對於大量咳血的病人，快速及正確的找到支氣管動脈源頭並予以栓塞是很重要的治療方法。由於支氣管動脈源頭有許多的變異性，所以傳統上以胸椎為支氣管動脈攝影的參考指標是不夠的。因此，我們回顧一些罹患致命性咳血病患的支氣管動脈攝影，分析左側主支氣管與左、右支氣管動脈源頭間的關係以了解左側主支氣管是否可供從事支氣管動脈攝影術的有用參考指標。 從1994年1月到2002年7月，共有31位病患因罹患致命性咳血接受支氣管動脈攝影術。由兩位放射診斷專科醫師重新審視這些血管攝影片並訂出左側主支氣管與左、右支氣管源頭間的關係。我們將這兩者的關係分為6個levels：（1）源頭在左側主支氣管上緣超過一個肋骨寬度；（2）源頭在左側主支氣管上緣不超過一個肋骨寬度；（3）源頭在左側主支氣管上半部；（4）源頭在左側主支氣管下半部；（5）源頭在左側主支氣管下緣不超過一個肋骨寬度；（6）源頭在左側主支氣管下緣超過一個肋骨寬度。 總共施行了51條支氣管動脈攝影，其中右支氣管動脈有27條，左支氣管動脈有24條。大部份右側支氣管動脈起源於左側主支氣管及其上、下一個肋骨寬度的位（level 2 到level 5），尤其是在左側主支氣管陰影的位置（level 3：33.3%及level 4：22.2%）。至於左支氣管動脈的起源則有較多的變異性，大約有一半起源於左側主支氣管陰影上方的位置（level 1：20.8%及level 2：25.0%）。 我們分析的結果發現在從事右側支氣管動脈攝影時，最有效的方法是從左側主支氣管陰影的位置（level 3及level 4）去找支氣管動脈開口，之後再找左側主支氣管陰影上、下一個肋骨寬度（level 2及level 5）的位置，最後再找左側主支氣管陰影上、下超過一個肋骨寬度（level 1及level6）的位置。相反的，在從事左側支氣管動脈攝影時則應由左側主支氣管陰影上方逐段找下來，即由level 1往level 6找是比較好的一個方法。
並列摘要
Rapid and accurate catheterization of bronchial artery is very important for emergent embolization treatment of massive hemoptysis. The origin of the bronchial artery is widely variable referred to the level of thoracic vertebrae, which makes it an unreliable localization reference. We, therefore, retrospectively analyzed the relationship between left main bronchus (LMB) and the origin of the left and right bronchial arteries in patients undergoing bronchial angiogram for life-threatening hemoptysis to determine whether the LMB can be as a radiographic landmark for catheterization of the bronchial artery. From January 1994 to July 2002, there were consecutively 31 patients underwent emergent bronchial angiogram to manage the life-threatening hemoptysis. Their bronchial angiograms were retrospectively reviewed by two attending radiologists to identify the relationship of the translucent shadow of the LMB and the origins of right and left bronchial arteries respectively. The anatomical relationship of the origin of a specific bronchial artery to the LMB was defined as six levels: (1) above the upper margin of LMB and beyond one rib-width, (2) above the upper margin of LMB but not beyond one rib-width, (3) within the upper-half shadow of LMB, (4) within the lower-half shadow of LMB, (5) below the lower margin of LMB but not beyond one rib-width, (6) below the lower margin of LMB and beyond one rib-width. There were totally 51 bronchial angiograms performed, including 27 right bronchial arteries and 24 left bronchial arteries. Most of the right bronchial arteries originated within the range between one-rib width above and below the LMB (level 2 to level 5), especially within the shadow of LMB (33.3% at level 3 and 22.2% at level 4). The origins of left bronchial arteries were more variable and about half of them originated above the LMB (20.8% at level 1 and 25.0% at level 2). Our findings suggested that an efficient way to catheterize right bronchial arteries should begin within the range of LMB shadow (levels 3 and 4), then one-rib width above and below LMB (levels 2 and 5), and finally beyond one-rib range (levels 1 and 6). In contrast, a reasonable catheterization procedure of left bronchial arteries should be performed following a craniocaudal sequence, i.e. from level 1 downward to level 6.