肺动脉吊带的临床诊疗经验

Diagnosis and treatment of pulmonary artery sling

目的：探讨肺动脉吊带（pulmonary artery sling,PAS）的临床诊疗经验。方法：分析2009年12月至2013年3月在重庆医科大学附属儿童医院心胸外科PAS患儿的临床资料。结果：16例PAS患儿于我科行手术治疗,所有患儿均以反复咳嗽、吼喘等呼吸道症状就诊,年龄2个月-3.5岁,体质量4.5-15 kg,按Cotton气管狭窄分期,Ⅰ期（管腔阻塞〈70%）：14例,单纯行左肺动脉移植术,13例痊愈出院,1例死亡;Ⅱ期（管腔阻塞70%-90%）：0例,Ⅲ期（管腔阻塞〉90%）：2例,行气管成形术,均死亡。结论：PAS患儿多为继发于异常走行血管压迫产生的Ⅰ期气管狭窄,不需要手术矫正气道狭窄;而合并Ⅱ、Ⅲ期气管狭窄,是否应积极行气管狭窄根治术,仍需进一步讨论。

Objective：To discuss the diagnosis and treatment of pulmonary artery sling（PAS）. Methods：Sixteen patients who diagnosed as PAS and received surgery in department of cardiothoracic surgery in the Children＇s Hospital of Chongqing Medical University Between December 2009 and March 2013 were enrolled. Results：Sixteen patients with PAS underwent the surgery and all cases had a history of recurrent cough and wheezing. The age of patients ranged from 2 months to 3.5 years and body weight ranged from 4.5kg to 15 kg. According to Cotton standard,14 patients in phase Ⅰ only received re-implantation of the left pulmonary artery（LPA）and 13 recovered;2 patients with trachea stenosis in phase Ⅲ received tracheoplasty at the same time but all died. Conclusion：For most PAS patients with trachea stenosis in phase Ⅰ,only re-implantation of the LPA may result in good results. For the PAS with trachea stenosis in phase Ⅱ and Ⅲ,early tracheoplasty for trachea stenosis remains to be discussed further.