婴幼儿血管环合并先天性气管狭窄的诊断与治疗  

Diagnosis and treatment of vascular ring associated with congenital tracheal stenosis in infants

作　　者：王涛[1] 谢艳丽[1] 汪力[1] 龚立[1] 皮名安[1] 

机构地区：[1]武汉市儿童医院心胸外科,430016

出　　处：《中华实用儿科临床杂志》2013年第7期556-558,共3页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨血管环合并先天性气管狭窄的手术方式，以降低手术风险。方法回顾性分析通过cT影像学检查、纤维支气管镜、彩色多普勒超声心动图等明确诊断的血管环患儿53例，年龄5．0d～2．5岁，中位年龄12．5个月，包括肺动脉吊带，双主动脉弓，右弓合并异常左锁骨下动脉，无名动脉压迫等。其中12例（男8例，女4例）伴气管狭窄症状。患儿均行手术治疗，8例死亡，出院病例随访3～5年，间隔时间6个月。结果53例患儿分为2组。41例（男25例，女16例）无气管狭窄的患儿行血管环矫治，3例死亡，病死率为7．3％。12例（男8例，女4例）血管环合并气管狭窄患儿，其中7例行选择性血管环矫治，2例死亡；5例行血管环矫治＋气管狭窄修补，3例死亡，病死率为41．7％。41例无气管狭窄的病例中，7例有心内畸形，2例死亡。12例合并气管狭窄的患儿，3例存在心内畸形，2例死亡；5例行心脏及气管联合手术，3例死亡，7例行选择性血管环修补，2例死亡。结论血管环合并气管狭窄的患儿，并不均需要同时矫治血管环及气管狭窄。气管狭窄、合并心内畸形均增加了血管环患儿的手术风险，对此类患儿需制订个体化的治疗方案。Objective To investigate the operation method for congenital tracheal stenosis（CTS） with vascular ring（VR） ,in order to minimize surgical risk. Methods The data of 53 VR patients diagnosed by CT imaging, fiber bronchoscope and color doppler echocardiography were analyzed retrospectively. The age ranged from 5.0 days to 2.5 yeas old,median age was 12.5 months, including pulmonary artery sling, double aortic arch, right arch combined with abnormal left subclavian artery and innominate artery oppression, et al. in which 12 patients （8 male .4 female） associated with CTS symptoms. All patients were treated by operations,8 patients were dead, others were followed up for 5 to 5 years at 6-month interval. Results Fifty-three patients with VR were categorized into 2 treatment groups. There were 41 patients（25 male,16 female） without CTS symptoms treated by VR repair（5 cases died） ,mortality was 7.3%. Of the 12 patients（8 male,4 female） with VR ＋ CTS symptoms,7 cases were treated by selective VR repair with 2 cases deaths ,5 cases underwent combined VR and CTS repairs with 3 cases died ,for an overall mortality of 41.7%. Of the 41 patients with VR but no CTS,7 cases had intracardiac anomalies with 2 cases died. In contrast,3 of 12 patients with VR ＋ CTS and intracardiac anomalies with 2 cases died ;5 patients received cardiac and CTS repairs （3 cases died） and 7 cases in selective VR repairs （2 cases died）. Conclusions Not all cases of TN associated with VR require combined correction. CTS and the combined cardiac abnormalities increased the risk of VR surgery in children. The individualized treatment program should be developed for such children.

关 键 词：血管环 先天性气管狭窄 个体化 婴幼儿 

分 类 号：R473.72[医药卫生—护理学]