儿童肺动脉吊带与双主动脉弓伴随的肺气管畸形比较

The difference of airway malformation between double aortic arch and pulmonary artery sling in children

目的：评价血管环中双主动脉弓与肺动脉吊带伴随的气管狭窄与气道畸形的异同。方法回顾性分析2010年7月至2015年7月的双主动脉弓和肺动脉吊带患儿的临床和螺旋CT影像学资料。结果双主动脉弓患儿16例，男11例、女5例，发病中位年龄3.5个月；肺动脉吊带患儿47例，男28例、女19例，发病中位年龄4个月。16例双主动脉弓患儿中14例伴随气道狭窄，累及多个分段者2例，均为累及分段Ⅱ、Ⅲ；仅累及1个分段者12例。47例肺动脉吊带患儿均发生不同程度气道狭窄，其中狭窄累及多个分段者27例，最常见的是同时累及分段Ⅱ、Ⅲ者19例；2例同时累及4个气道段，仅累及1个气道分段者20例。两者累及气道分段数量差异有统计学意义（χ2=13.588，P=0.001）。16例双主动脉弓患儿合并气管性支气管1例，合并肺发育不良1例；47例肺动脉吊带患儿中合并支气管桥8例，合并气管性支气管3例，合并肺发育不良3例，支气管缺如（或气管憩室）5例，合并肺前肠畸形2例。两者合并气道畸形的差异有统计学意义（χ2=5.333，P=0.021）。结论肺动脉吊带合并的气道狭窄和气道肺畸形较双主动脉弓更为突出。

Objective To evaluate the difference of tracheobronchial stenosis and airway malformation between double aortic arches and pulmonary artery sling in children. Methods Clinical feature and imaging data of spiral CT were retrospectively analyzed in children with double aortic arches or pulmonary artery sling who was hospitalized from July 2010 to July 2015 . Results There were 16 children （ 11 males and 5 females） with double aortic arches whose median age at onset was 3 . 5 months old. There were 47 children （ 28 males and 19 females） with pulmonary artery sling whose median age at onset was 4-month-old. In these 16 cases of double aortic arches, 14 cases were coupled with tracheobronchial stenosis. Two cases had more than one segment involved and they were segments II or III. Twelve cases had only one segment involved. Different degrees of tracheobronchial stenosis occurred in 47 cases of pulmonary artery sling, among whom 27 cases had more than one segment involved and the common segment was II and III （ 19 cases）. Two cases had four segments involved and 20 cases had only one segment involved. There was statistical signiifcance in the number of involved segments between children with double aortic arches and pulmonary artery sling （χ2=13 . 588 , P=0 . 001 ）. In 16 cases of double aortic arches, one case was combined with tracheal bronchus, and 1 case was combined with pulmonary hypoplasia. In 47 cases of pulmonary artery sling, 8 cases were combined with bridging bronchus, 3 cases combined with tracheal bronchus, 3 cases combined with pulmonary hypoplasia, 5 cases combined with bronchial deifciency or tracheal diverticula, and 2 cases combined with bronchopulmonary foregut malformation. There was statistical signiifcance in the number of cases combined with airway malformation between children with double aortic arches or pulmonary artery sling （χ2=5 . 333 , P=0 . 021 ）. Conclusions The tracheobronchial stenosis and pulmonary airway abnormalities are more prominent in children with pulmonary artery sling than those in children with double aortic arch.