摘要
目的总结婴幼儿先天性血管环外科诊治的临床经验。方法2009年9月至2010年12月诊断并手术治疗14例血管环患儿，其中男9例，女5例；年龄2月～6岁；体重4．5～15．0kg。所有病例术前均行X线胸片、超声心动图及增强多排螺旋CT检查确诊，行食管造影及纤维支气管镜检查各5例。病理类型包括双主动脉弓1例、肺动脉吊带7例、右位主动脉弓伴左位动脉导管／韧带6例，7例患儿合并心内畸形。全组患儿存在不同范围（12％～62％）和程度（45％～74％）的气管狭窄，5例术前存在局限性食管狭窄。12例患儿在体外循环下手术同期矫治心内畸形，2例在非体外循环下手术。结果术后辅助呼吸7～308h，中位数21h；ICU停留16～314h，中位数79．5h。1例肺动脉吊带患儿住院死亡（7．1％）。13例出院。失访1例，12例随访1～15个月，患儿消化道症状消失，活动耐力改善。呼吸道症状不同程度缓解，5例（41．7％，5／12例）仍然存在呼吸道症状。结论临床上对有长期呼吸道和（或）消化道症状的患儿需考虑血管环的可能，增强CT是确定血管环诊断的最佳方法。血管环应尽早手术治疗，合并的长段气管狭窄需手术治疗，近一中期效果良好。
Objective To explore the diagnosis and surgical treatment experience of vascular ring in infants and children. Methods Fourteen cases （9 boys and 5 girls, aged 2 months to 6 years, weighted 4.5 - 15.0 kg） with vascular ring were diagnosed and treated surgically in Children＇s Hospital of Chongqing Medical University from Sep. 2009 to Dec. 2010. All children underwent X-ray, echocardiography and spiral computed tomography examination preoperatively. Bronchoscopy and barium swallow was performed in 5 cases respectively. The pathological types of vascular rings included double aortic arch in 1 （ 7.1% ） , pulmonary artery sling in 7 （50.0%） , right aortic arch with left patent ductus arteriosus or persistent left ligament in 6 （42.9%）. Associated cardiac anomalies were present in 7 （50.0%） patients. Tracheal stenosis of different length （12% -62% ） and severity （45% -74% cross-sectional luminal narrowing） was observed in the group. Barium swallow in 5 cases showed localized compression of the esophagus. 12 cases underwent repair of vascular ring with eardiopulmonary bypass （CPB） , and the associated congenital heart defects were repaired simultaneously. 2 cases of right aortic arch with left patent duetus arteriosus or persistent left ligament underwent surgery without CPB. Results The median duration of CPB in 12 cases and aortic cross-clamp time in 7 patients were 77.5 minutes （range： 55 -186 minutes） and 36 minutes （range： 22 -110 minutes） respectively. The median duration of postoperative ventilation and ICU stay were 21 hours （range： 7 -308 hours） and 79.5 hours （range： 16- 314 hours） respectively. One baby with pulmonary artery sling died on the postoperative 12th day （ in-hospital mortality 7.1% ）. Of the 13 cases discharged from the hospital, 1 case were lost to follow up. In the follow-up （ 1 - 15 months） of 12 cases, digestive symptoms were disappeared. Development, exercise tolerance and symptoms showed obvious improvement, although 5 （41.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2011年第10期577-580,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
心脏缺损
先天性
婴儿
儿童
心脏外科手术
血管环
Heart defect, congenital Infant Child Cardiac surgical procedures Vascular ring
