小儿血管环外科治疗的单中心临床分析  

Clinical analysis of surgical correction for congenital vascular ring in children in a single center

作　　者：高漫辰 董硕 段亚冰 孙阳雪 李嘉晨 王菊[1] 王强[1] 李守军[1] 花中东[1] 闫军[1] GAO Manchen;DONG Shuo;DUAN Yabing;SUN Yangxue;LI Jiachen;WANG Ju;WANG Qiang;LI Shoujun;HUA Zhongdong;YAN Jun(Department of Pediatric Cardiac Surgical Center,Fuwai Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing,100037,P.R.China)

机构地区：[1]中国医学科学院北京协和医学院阜外医院小儿心脏外科中心,北京100037

出　　处：《中国胸心血管外科临床杂志》2021年第10期1242-1247,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家重点研发计划资助(2017YFC1308100)。

摘　　要：目的探讨儿童血管环的最佳解剖分型、手术时机、手术方法和治疗效果。方法回顾性分析阜外医院小儿心脏外科中心2014~2019年各类血管环手术治疗58例患儿的临床资料,其中男32例(55.2%)、女26例(44.8%),中位年龄16.5(2~73)个月。对术前症状、影像学检查、血管环分类、手术方法、术后恢复等进行总结分析。结果全组患儿双主动脉弓畸形20例(34.5%),右位主动脉弓伴左侧动脉导管或韧带22例(37.9%),左位主动脉弓伴迷走右锁骨下动脉15例(25.9%),回旋主动脉伴颈位主动脉弓1例(1.7%)。中位呼吸机辅助时间6.0(0~648)h,中位住院时间14.5(7~104)d。全组共1例合并主动脉缩窄患儿围术期因重症肺部感染死亡,其余患儿出院后无症状生存,无再次手术,中位随访时间7.0(1~62)个月。结论对于原发病无法解释的呼吸困难及吞咽困难,或存在右位主动脉弓的患儿,需要术前完善CT或磁共振成像等影像学检查,以明确血管环诊断。手术治疗血管环安全可靠,能有效缓解症状,手术成功率高,再次手术干预率低,随访效果满意。Objective To investigate the best anatomical classification, surgical timing, procedure and clinical outcomes of congenital vascular ring. Methods The clinical data of 58 patients who underwent congenital vascular ring surgery in Pediatric Surgery Center, Fuwai Hospital between 2014 and 2019 were retrospectively analyzed. There were 32(55.2%) males and 26(44.8%) females with a median age of 16.5(2-73) months. Preoperative symptoms, imaging examinations, anatomical classifications, surgical procedures and postoperative recovery were assessed. Results There were 20(34.5%) patients of double aortic arch, 22(37.9%) patients of right aortic arch with left arterial duct or ligament,15(25.9%) patients of left aortic arch with aberrant right subclavian artery, and 1(1.7%) patient of circumflex aorta with cervical aorta arch. The median ventilator supporting time was 6.0(0-648) h, and the median hospital stay time was 14.5(7-104) d. One patient with coarctation of aorta died of severe pulmonary infection during perioperative period, and the others survived without symptoms and reoperation after discharge. The median follow-up time was 7.0(1-62) months.Conclusion For children with unexplained dyspnea and dysphagia, or with right aortic arch, preoperative imaging examinations such as computed tomography or magnetic resonance imaging are required to confirm the diagnosis of vascular ring. Surgical correction of congenital vascular ring is safe and reliable, and can effectively relieve symptoms. The mortality rate and reoperation rate are low, and the follow-up results are satisfactory.

关 键 词：血管环 双主动脉弓 右位主动脉弓 迷走锁骨下动脉畸形 

分 类 号：R726.5[医药卫生—儿科]