多排螺旋CT在小儿法乐四联症诊治中的应用价值  

Evaluation of multidetector-row computed tomography angiography for children with Tetralogy of Fallot

作　　者：舒涛[1] 蔡国祥[2] 孙勇[1] 苏茂龙[3] 强海峰[1] 廖崇先[1] 

机构地区：[1]厦门大学附属中山医院心血管外科,361004 [2]厦门大学附属中山医院影像科 ,361004 [3]厦门大学附属中山医院超声科,361004

出　　处：《中华小儿外科杂志》2010年第1期4-7,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨多排螺旋CT血管造影（MUCTA）三维重建应用于小儿法乐四联症（TOF）诊断及治疗中的价值。方法2004年12月至2008年12月38例经胸二维超声心动图（TEE）诊断TOF患儿，为进一步明确肺动脉发育状况行MUCTA检查，均经外科手术证实。MUCTA扫描后应用三维重建处理，测算全肺动脉指数（Nakata），确定肺动脉发育状况，冠状动脉走向，主、肺动脉侧枝循环位置，设计手术方案。结果38例患儿检查过程顺利均为TOF，其中合并房间隔缺损（ASD）3例、动脉导管未闭（PDA）2例、室间隔缺损（VSD）嵴下型38例，单纯右室流出道狭窄7例、合并肺动脉狭窄31例，冠状动脉走向异常2例、主、肺动脉侧枝循环19例、其中粗大俱4枝循环3例。35例康复出院，3例术后死亡。结论MUCTA对于诊断TOF心外畸形的显示清晰度超过其它影像学检查，特别是对观察肺动脉发育形态、肺动脉狭窄的部位、冠状动脉起源与走向异常、PDA、主肺动脉侧枝循环，精确测算Nakata指数、McGoon指数均有明显帮助。与TEE相结合能达到优势互补、能够更加完整、准确的诊断TOF，为手术决策，方案的制定提供了有效的依据，对提高TOF患儿的治疗效果有重要价值。Objective To evaluate the multidetector-row computed tomography angiography （MUCTA） used in diagnosis and treatment of children with Tetralogy of FaIlot （TOF）. Methods Between December 2004 and December 2008, 38 patients with TOF were assessed using echo-doppler （TTE） and MUCTA. Three dimensional images were constructed to assess the pulmonary artery a- nomalies, anomalies of the coronary artery and aorta-pulmonary collateral arteries. McCmon and Naka- ta indices were obtained in preparation for corrective surgery. Results A total of 38 patients were scanned using MUTCA and anomalies were diagnosed as TOF with ventricular septal defects （VSD） . Two of these patients also bad atrial septal defects （ASD） and three had patent ductus arteriosus （PAD）. Seven had right ventricular outlet stenosis. Thirty- one patients with arterial stenosis inclu- ding pulmonary arterial branch stenosis, six with left sided and eight with right sided stenosis all of which developed pulmonary arterial branch enlargement. Two had coronary artery anomalies, nineteen had aorta-pulmonary anomalies which three of these had enlarged collaterals. With the use of MUCTA and TTE, we were able to plan the surgical procedures pre-operatvely. This was otherwise not possi- ble. Thirty-five of the patients recovered while the remaining three patients died peri-operatively. Conclusions MUCTA is a more accurate imaging than other modalities for the assessment of pulmonary artery.

关 键 词：法乐四联症 体层摄影术 螺旋计算机 血管造影术 

分 类 号：R72[医药卫生—儿科] R816[医药卫生—临床医学]