婴幼儿血管环的早期诊治  

Early diagnosis and treatment of vascular ring in infants

作　　者：龚立[1] 皮名安[1] 郑楠楠[1] 姚文艳[1] 王涛[1] 汪力[1] 

机构地区：[1]武汉市儿童医院心胸外科,武汉430016

出　　处：《中华小儿外科杂志》2012年第8期575-578,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的总结先天性血管环的早期诊断方法和手术治疗效果。方法回顾性分析2008年3月至2011年7月本院手术治疗的16例先天性血管环患儿的临床资料。其中男11例，女5例。年龄4个月至3．2岁，平均（2．2±1．7）岁。术前均行64排CT胸部大血管及气管三维重建检查。诊断双主动脉弓3例；右位主动脉弓伴左侧韧带和左迷走锁骨下动脉7例；右位主动脉弓伴迷走左无名动脉干1例，左位主动脉弓伴右迷走锁骨下动脉2例；肺动脉吊带3例。患儿临床表现为反复呼吸道感染、慢性咳嗽、喘鸣、呼吸窘迫、吞咽困难及呕吐。手术13例，3例肺动脉吊带患儿在体外循环下手术；其余患儿在非体外循环下手术，1例加行主动脉悬吊术。结果所有患儿均生存，术后顺利脱离呼吸机，1例出现乳糜胸，1例出现左侧声带麻痹。术后随访平均6个月，所有患儿术后2周消化道症状消失，6例患儿术后3个月仍有喘鸣，反复呼吸道感染，2例患儿术后6个月仍有喘鸣，慢性咳嗽。术后1年，仅有1例患儿仍有喘鸣，但发作频率较前明显减少，生长发育正常。结论对反复出现肺炎、呼吸困难、不明原因喘鸣、吞咽困难等婴幼儿，应高度警惕有无血管环的可能，尽早行CT检查明确诊断，如不合并有其他畸形，早期发现、早期治疗，手术治疗效果良好。Objective This study aimed to summarize the method of diagnosis and surgical treatment for congenital vascular ring in infants. Methods A retrospective analysis of clinical data of 16 cases （male = 11; female = 5） with congenital vascular rings from March 2008 to July 2011were conducted. Patients＂ agesranged from 4 months to 3. 2 years old （mean 2. 2 years 1.7）. Preoperative 64- slice CT chest with three-dimensional reconstruction of the great vessels and trachea were performed. The diagnosis included double aortic arch in 3 cases; right aortic arch with left ligament and aberrant left subclavian artery in 7 cases; right aortic arch with aberrant left innominate artery in I case, left aortic arch with aberrant right subclavian artery in 2 cases; pulmonary artery sling in 3 cases. Clinical manifestations of childrenincluded recurrent respiratory tract infection, chronic cough,wheezing, respir- atory distress, dysphagia, and vomiting. 13 patients underwent surgical repair; 3 cases of pulmonary ar- tery sling had surgery under cardiopulmonary bypass; while the others had off-pump surgery, including 1 case of aortopexy surgery. Results No operative mortality was seen in any patient. Postoperative complication included I case of chylothorax and I case of left vocal cord palsy. The mean follow-up pe- riod was 6 months. Gastrointestinal symptoms disappeared 2 weeks after the operation. 6 patients still had wheezing,recurrent respiratory tract infection 3 months after the operation. By 6 months, 2 pa- tients had wheezing, and chronic cough. Only i patient still had wheezel year after operation. Signifi cant reduction of seizure frequency was obtained comparing with the previous status and normal growth and development were achieved. Conclusions In infants and young children with recurrent pneumonia, breathing difficulties unexplained wheezing, dysphagia, the possibility of vascular ring should be borne in mind. Early detection, and surgical treatment should be offered.

关 键 词：血管环 先天性 主动脉弓 婴儿 

分 类 号：R725.4[医药卫生—儿科]