肺静脉异位引流的经胸超声心动图影像与手术对照分析  

Comparative Analysis of Transthoracic Echocardiography and Operation of Anomalous Pulmonary Venous Connection

作　　者：牛义翠 马慧 弓文清 赵晓妮 胥盼 郑敏娟 Niu Yicui;Ma Hui;Gong Wenqing;Zhao Xiaoni;Xu Pan;Zheng Minjuan(Department of Ultrasound Medicine,Xijing Hospital,Air Force Medical University,Xi'an,Shanxi 710032,China)

机构地区：[1]空军军医大学西京医院超声医学科,西安市710032

出　　处：《中国超声医学杂志》2020年第9期810-813,共4页Chinese Journal of Ultrasound in Medicine

基　　金：院新技术课题资助(No.XJGX15Y16)。

摘　　要：目的评价经胸超声心动图(TTE)诊断175例肺静脉异位引流(APVC)的价值并分析误诊原因,提高诊断率。方法回顾性分析我院175例经胸超声心动图诊断APVC患者的超声影像资料并与手术结果对照,分析诊断价值及误诊原因。结果175例患者均接受手术,166例最终确诊为APVC。部分型比例更高(PAPVC 61.4%vs TAPVC 38.6%)。超声诊断符合率为94.9%,分型准确率分别为94.1%(PAPVC)、100%(TAPVC)。9例误诊均系单纯静脉窦型房间隔缺损,误诊原因为旁四腔切面右上肺静脉假性骑跨于房顶(房缺较大、位高)、右上肺静脉血流与过隔血流混淆所致(9/9,100%)。分型错误最常见者为心上型误诊为心内型。与PAPVC组相比较,TAPVC组合并其他心内畸形率更高,右心增大及肺动脉高压者更多(P<0.05)。结论TTE诊断APVC及其伴发畸形具有较高的准确率,但对于单支右侧肺静脉易误判,需注意甄别右上肺静脉假性骑跨、过隔血流混淆并注意观察上腔静脉近心端,减少漏诊与误诊,必要时结合其他影像学检查。Objective To analyze the causes of misdiagnosis on anomalous pulmonary venous connection(APVC)by transthoracic ultrasonography(TTE),and to improve the diagnostic accuracy.Methods The data of 175 cases of APVC diagnosed by transthoracic echocardiography in our hospital were retrospectively analyzed and compared with the results of surgery.Results All 175 patients accepted surgery and 166 were confirmed APVC.Partially anomalous pulmonary venous connection(PAPVC)showed higher incidence compared with totally anomalous pulmonary venous connection(TAPVC)(61.4%vs 38.6%).The accuracy of TTE diagnosis on APVC was 94.9%,classification accuracy was 94.1%in PAPVC and 100%in TAPVC,respectively.9 cases of single sinus venosus type atrial septum defect(ASD)were misdiagnosed as ASD combined PAPVC,because the superior right pulmonary vein pseudo-ride acrossed the atrial roof on 4-chamber view,and PV flow mixed with the ASD flow(9/9,100%).For type classification,the most common error was that supra-cardiac type misdiagnosed as the intra-cardiac type.Other intracardiac malformations showed higher incidence in TAPVC compared with PAPVC group,and the ratios of right ventricle enlargement,pulmonary hypertension(PH)showed higher(P<0.05).Conclusions TTE shows high accuracy in the diagnosis of APVC,but it is easy to misjudge for single right pulmonary vein abnormal,so attention should be paid to the false straddling of the right superior pulmonary vein to reduce misdiagnosis.

关 键 词：肺静脉异位引流 经胸超声心动图 误诊 手术 肺动脉高压 

分 类 号：R445.1[医药卫生—影像医学与核医学] R543.6[医药卫生—诊断学]