66例儿童法洛四联症体肺侧支的分布规律及形态学特征分析

Distribution and morphological characteristics of 66 patients with aortopulmonary collaterals in tetralogy of fallot

目的:探讨法洛四联症(TOF)患者体-肺侧支血管(APCAs)的分布规律及形态学特征。方法:回顾性分析2010年3月-2014年12月本院66例经手术确诊的TOF合并APCAs患者的CTA资料,总结并分析APCAs的数量、分布规律及形态学特征。结果:(1)66例患者共发现APCAs 176支,平均2.67支/例。起源部位以胸主动脉中段为主(64支),其后依次为胸主动脉上段和下段、主动脉弓上血管和主动脉弓、腹主动脉及升主动脉。按APCAs类型,Ⅰ型(支气管动脉来源)5支(2.84%),Ⅱ型(主动脉直接来源)144支(81.82%),Ⅲ型(主动脉间接来源)27支(15.34%)。开口狭窄的APCAs 11支,占总数的6.18%。大部分APCAs走行迂曲(166支,占比94.32%)且具有分支(137支,占比77.84%)。(2)APCAs开口起自近心面77支(占48.73%);起自侧面81支,占51.27%;未见开口于背心面的APCAs。APCAs起始部管径以2~4mm最多,为90支,约占51.14%;小于2mm者83支,约占47.16%;大于4mm者最少,仅3支,约占1.70%。(3)APCAs与肺动脉的连接方式以中心融合为主,共243支,约占60.90%;其次为远端融合,共116支,占29.07%;单独分布者最少,为40支,占10.03%。结论:TOF患者中APCAs的分布和形态呈现多样性,应引起重视。

Objective:To summarized the distribution and the morphological characteristics of patients with aorta-pulmonary collateral arteries(APCAs)in tetralogy of fallot(TOF).Methods:We retrospectively analyzed the computed tomography angiography(CTA)images data of 66 TOF patients with APCAs from March 2010 to December 2014.Distribution,number and the morphological features of APCAs were recorded and summarized.Results:①Totally 176 APCAs were found(mean 2.67/case)in 66 cases.In this group,the APCAs was found mainly at the middle part of thoracic aorta(n=64),followed by the superior part of the thoracic aorta,inferior part of thoracic aorta,branches of aortic arch,aortic arch,abdominal aorta and the ascending aorta.According to the classification of the APCAs,there were 5 branches of the bronchial artery(TypeⅠ,2.84%),144 aortic direct branches(typeⅡ,81.82%),27 indirect branches of aorta to be found(TypeⅢ,15.34%).A total of 11 stenosis APCAs were found in this group,accounting for 6.25%of all the APCAs.Most APCAs had squirm twist before turning into lungs and have branches,which number was 166 and 137 respectively,and the proportion was 94.32%and 77.84%.②Our reults demonstrated that 77 APCAs originated from the proximal side of accounting for 48.73%;83 in the lateral side,accounting for 51.27%.There were no APCAs originated from the opposite side.In this group,the diameters of 90 APCAs were between 2mm and 4mm(accounting for 51.14%),83 APCAs were less than 2mm in diameter(accounting for 47.16%),only 3 APCAs were more than 4mm in diameter(accounting for 1.70%).③We found that the connection mode of APCAs and pulmonary artery was mainly central integration(total of 243 branches,accounting for 60.90%),followed by distal fusion(116 branches),separate distribution(40 branches),accounting for 29.07%and 10.03%respectively.Conclusion:In TOF patients,APCAs distribution and morphology presented diversity,which should be pay attention to.