漏斗胸患者手术前后小气道改变评估中多层螺旋CT应用价值研究

Clinical value of multi-slice spiral CT in evaluation of small airway changes in patients with pectus excavatum before and after operation

目的:探讨多层螺旋CT在漏斗胸患者手术前后小气道改变评估中的临床应用价值。方法:选取漏斗胸患儿58例作为研究组,另选取58例正常儿童为对照组。采用多层螺旋CT检查Haller指数、小气道改变、左肺下叶病变的情况以及心脏旋转角度的变化情况。结果:通过多层螺旋CT观察漏斗胸不同凹陷程度的测量指标分析对比,胸骨凹陷深度(L)加大、CT凹陷指数(b/a)增大、胸骨凹陷角度(β)变小,表明胸骨向胸椎方向凹陷程度越重;通过多层螺旋CT扫描Haller指数、小气道病变、左肺下叶病变在不同凹陷程度的情况分析,胸前凹陷程度(轻、中、重度)中的Haller指数、小气道病变、左肺下叶改变情况的变化对比,中、重度情况显著升高,具有统计学差异(P<0.05);通过术前术后Haller指数及心脏旋转角度测量情况分析中,术前与术后的Haller指数、心脏旋转角度比较有统计学差异(P<0.05),而研究组中术前与对照组的Haller指数、心脏旋转角度,两者比较有统计学差异(P<0.05),而术后与对照组的Haller指数、心脏旋转角度比较无统计学差异(P>0.05);通过CT在不同年龄段手术前后小气道改变结果情况分析显示,<3岁与>6岁患儿术前、术后结果对比无统计学差异(P>0.05),而在3~6岁中的术前与术后对比具有统计学差异(P<0.05),表明年龄小于3岁以内的患儿术前小气道改变程度较轻,术后恢复快;3~6岁患儿术前小气道功能改变程度较高,术后恢复一般;而大于6岁患儿术前小气道功能明显降低外,大气道功能也随着减低,术后恢复差。结论:多层螺旋CT能够全面、准确地评价漏斗胸的胸廓凹陷畸形程度和小气道改变情况,且简便易行。

Objective:To investigate the clinical significance and value of multi-slice spiral CT in the assessment of small airway changes before and after surgery in patients with funnel chest.Methods:A total of 58 children with funnel chest who were treated with cardiothoracic surgery in our hospital were selected as study group,and 58 normal children were selected as control group.Multi-slice spiral CT was used to examine Haller index,small airway changes,the lesions in the left lower lobe and the changes in the angle of rotation of the heart.Results:Increased depth of sternal depression(L),increased CT depression index(b/a),and decreased angle of sternal depression(β)indicated that the degree of depression of the sternum toward the thoracic vertebrae was heavier.The Haller index in the degree of chest sag(light,moderate,severe),the changes of small airway lesions and left lower lobe changes were significantly increased in moderate and severe cases(P<0.05).There were statistical differences in the Haller index and the angle of rotation of the heart before and after surgery(P<0.05).There were statistical differences in the Haller index and the angle of rotation of the heart between study group before surgery and control group(P <0.05),but there were no statistical differences in the Haller index and the angle of rotation of the heart between study group after surgery and control group(P>0.05).There was no significant difference in small airway changes in children aged<3 years and those aged>6 years between before and after surgery(P>0.05),but there was statistical difference in children aged 3 to 6 years(P<0.05).These indicated that children aged<3 years had less changes in small airway before surgery and recovered quickly after surgery;children aged 3 to 6 years had higher changes in small airway function before surgery and had moderate recovery after surgery;children aged>6 years had significant decrease in small airway function before surgery,their airway function also decreased,and the postoperative recovery was poor.Conclusion:Multi-slice spiral CT can comprehensively and accurately evaluate the degree of thoracic cavity depression and small airway changes in the funnel chest,and it is simple and easy to implement.