婴儿及新生儿血管环并呼吸道压迫的诊断与治疗

Diagnosis and Management of Vascular Ring Combined with Tracheal Compression in Infants and Neonates

目的探讨婴儿及新生儿血管环并呼吸道压迫的诊断与治疗方法。方法2004年6月-2009年12月广东省人民医院收治、经手术证实的血管环并呼吸道压迫婴儿及新生儿16例(男7例,女9例;年龄1 d～12个月),其中13例并心内畸形。患儿均行胸片、心脏超声及螺旋CT检查,其中9例行纤维支气管镜检查。15例于体外循环下行血管环松解术,1例行血管环松解术+心包补片扩大气管成形术。11例在术中同时治疗心内畸形。结果肺动脉吊带5例(其中1例并气管环),右位主动脉弓/左侧韧带或迷走左锁骨下动脉8例,双主动脉弓1例,无名动脉压迫综合征1例,肺动脉吊带、左位主动脉弓/迷走右锁骨下动脉形成2处血管环并气管环1例。超声心动图漏诊9例。16例CT检查均诊断为血管环。纤维支气管镜检查见气管受压。其中14例治愈或症状消失出院,2例并气管环者死亡。随访11例,其中5例术后仍间断有轻度喘息发作。结论婴儿及新生儿血管环并呼吸道压迫多表现为气促、喘鸣及呼吸困难,螺旋CT在该病诊治中具有重要作用。血管环松解术能使其呼吸道受压情况缓解,气管狭窄明显者应同时行气管成形术。

Objective To explore the diagnosis and therapy experience of vascular ring combined with tracheal compression in infants and neonates. Methods Sixteen cases （including 7 boys and 9 girls, aged 1 day to 12 months）with vascular ring combined with tracheal compression hospitalized in Guangdong General Hospital from Jun. 2004 to Dec. 2009 were enrolled. In these 16 children, 13 cases had congenital heart malformations. All children underwent X - ray, echocardiography and spiral computed tomography examination. Nine cases received bronchoscopy study. Fifteen cases performed surgical division of vascular ring with cardiopulmonary bypass and 1 case underwent vascular ring division and tracheoplasty. Eleven cases received management of congenital heart defect simultaneously. Results Vascular ring anomalies included puhnonary artery sling in 5 children,right aortic arch - left ligmentunr/aberrant left subclavian artery in 8 cases, double aortic arch in 1 case,innominate artery compression in 1 case,and pulmonary sling combined with right aortic arch - aberrant left subclavian artery in 1 case. There were 2 ring - sling complex cases in this study. The diagnosis of vascular ring were correctly made by echocardiography in 7 children and made by spiral computed tomography in all 16 cases. Two cases combined with tracheal ring died. In the follow - up study of I 1 cases ,5 cases were still vulnerable to wheezing. Conclusions The common presentation of tracheal compression in infants and neonates associated with vascular ring are tachypea, stridor,and dyspnea. Multi- slices spiral computed tomography is an important imaging modality. Surgical divisions of vascular ring are safe procedure in most cases and tracheal compression can be relieved by this operation. In patients with severe tracheal stenosis,tracheoptasty should be recommended.