左肺动脉吊带矫治术的单中心疗效分析  

Analysis of the Surgical Effects on Left Pulmonary Artery Sling:a Single-center Experience

作　　者：李培[1] 李晓峰[2] 王芳韵[1] 马宁[1] 张鑫[1] 彭芸[3] 伊寒露 郭张科 LI Pei;LI Xiaofeng;WANG Fangyun;MA Ning;ZHANG Xin;PENG Yun;YI Hanlu;GUO Zhangke(Department of Echocardiography,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing(100045),China)

机构地区：[1]国家儿童医学中心/首都医科大学附属北京儿童医院心脏超声科,北京市100045 [2]国家儿童医学中心/首都医科大学附属北京儿童医院心脏外科,北京市100045 [3]国家儿童医学中心/首都医科大学附属北京儿童医院影像中心,北京市100045

出　　处：《中国循环杂志》2020年第8期781-785,共5页Chinese Circulation Journal

摘　　要：目的:总结儿童左肺动脉吊带的临床特点、诊断及手术疗效。方法:选取我院2010年1月至2019年1月手术治疗的51例左肺动脉吊带病例,年龄2个月至11岁7个月,中位年龄5.5个月,体重3.5~35.0 kg,男32例,女19例。进行超声心动图、CT及支气管镜检查。根据手术方式分为非气管手术组(n=47)以及气管支架组(n=4),术后1个月、4个月、1年应用超声心动图随访。结果:术后45例患儿好转,1例死亡,5例自动出院。非气管手术组患儿中,43例术后好转;4例术后呼吸衰竭难以纠正自动出院,2例为"环-吊带复合体",1例合并气管下段软化,1例气管下段重度狭窄。气管支架组患儿中2例术后好转;2例术后氧合难以维持,1例气管多处狭窄自动出院,1例为"环-吊带复合体"术后死亡。43例患儿完成术后1年随访,呼吸道症状均有不同程度改善,超声心动图随访可见,左肺动脉发育改善,吻合口未发生梗阻。结论:左肺动脉吊带矫治术可缓解大多数气管压迫症状,气道梗阻明显可行气管支架手术,但气管多处严重狭窄效果不佳。"环-吊带复合体"、重度气管狭窄等患儿预后不良,可考虑行气管成形术。Objectives:To summarize the clinical characteristics,diagnostic methods and surgical effects of left pulmonary artery sling in children.Methods:A total of 51 patients,who underwent surgery of the left pulmonary artery sling from January 2010 to January 2019 in Beijing Children’s Hospital,were enrolled in this study.Age of the patients ranged from 2 months to 11 years and 7 months,the median age was 5.5 months.There were 32 males and 19 females,weight ranged from 3.5 to 35.0 kg.Echocardiography,CT and bronchoscopy were performed in all patients.The patients were divided into two groups according to the surgical methods:non-tracheal surgery group(n=47)and tracheal stent surgery group(n=4).Echocardiographic followup was performed at 1 month,4 months,and 1 year after the operation.Results:After surgery,45 cases experienced improvement,1 patient died,and 5 cases discharged automatically.In the non-tracheal surgery group,43 cases improved after surgery,4 cases experienced refractory postoperative respiratory failure and automatically discharged.Two of them had"ring-sling complex",one accompanied lower trachea softening,another one had severe stenosis of the lower trachea.In the tracheal surgery group,2 cases improved after surgery,2 cases failed to maintain the oxygenation.One of them had several severe stenosis of trachea and discharged automatically,the other one had"ring-sling complex"and died after surgery.Forty-three patients were followed up until 1 year after surgery,and respiratory symptoms improved to varying degrees.Echocardiographic follow-up results showed improvement in the development of the left pulmonary artery,and no anastomotic obstructions occurred.Conclusions:Surgical repair of left pulmonary artery sling can alleviate the symptoms of airway compression in most patients.Tracheal stent could be used on the patients with obviously airway obstruction but is not that effective on patients with severe tracheal stenosis in multiple airways.Patients with“ring-sling complex”and severe tracheal stenosi

关 键 词：左肺动脉吊带 血管环 儿童 治疗 

分 类 号：R541[医药卫生—心血管疾病]