肺动脉吊带的经胸超声心动图诊断价值及临床预后分析

Value of transthoracic echocardiography for and clinical prognosis of pulmonary artery sling

目的分析经胸超声心动图(TTE)对肺动脉吊带(PAS)的诊断价值,并对其临床特点及预后进行探讨,旨在提高本病的诊治水平。方法收集本院2013年10月至2018年2月26例PAS患儿的相关资料,26例均行TTE及CT血管造影(CTA),15例行纤维支气管镜检查。回顾性分析TTE对PAS的诊断准确率及声像图表现,并对其中22例手术治疗患儿进行随访,分析其临床预后。结果本组26例均经CTA证实为PAS。TTE确诊23例,准确率88.46%,TTE误诊2例,漏诊1例,漏误诊率11.54%。PAS表现为主肺动脉(MPA)直接延续为右肺动脉(RPA),左肺动脉(LPA)全部或部分起源于RPA并形成血管环,气道不同程度狭窄。本组12例合并其心内畸形,3例合并心外畸形;22例患儿行LPA重建术,术后存活16例组(46.15%),死亡组6例(27.27%);单因素分析发现,两组气道狭窄指数及合并完全性软骨环差异有统计学意义(均P<0.05)。结论TTE适用于PAS的诊断及随访,但也存在漏误诊,且无法直接观察气道情况,需结合CT及纤维支气管镜检查。手术是解除LPA压迫的主要方法,气道狭窄指数及合并完全性软骨环可能为术后患儿死亡的高危因素。

Objective To analyze the diagnostic value of transthoracic echocardiography(TTE)for pulmonary artery sling(PAS),and to improve the diagnosis and treatment of this disease by discussing its clinical characteristics and prognosis.Methods The data of 26 children with PAS treated at our hospital from Octoober,2013 to February,2018 were collected.All the 26 cases underwent TTE and CT angiography(CTA),and 15 underwent fiberoptic bronchoscopy.The diagnostic accuracy and sonograms of TTE for PAS were retrospectively analyzed.Twenty-two children who took surgical treatment were followed up to analyze their clinical prognosis.Results All the 26 cases were confirmed with PAS by CTA.TTE diagnosed 23 cases,with an accuracy rate of 88.46%,and misdiagnosed 2 cases and missed 1 case,with a rate of 11.54%.In the children with PAS,their main pulmonary arteries(MPA)directly continued to be the right pulmonary arteries(RPA),while the left pulmonary artery(LPA)completely or partially originated from RPA and formed a vascular ring,and their airways were narrowed to different degrees.In this group,12 cases were complicated with intracardiac malformation,and 3 with extracardiac malformation.Twenty-two children underwent LPA reconstruction,and 16 survived(46.15%)and 6 died(27.27%);univariate analysis showed that there were statistical differences between the two groups in airway stenosis index and combined complete cartilage ring(both P<0.05).Conclusion TTE is suitable for the diagnosis and follow-up of PAS,but there are also missed and misdiagnosed cases,and the airway cannot be directly observed.Therefore,CT and fiberoptic bronchoscopy should be combined.LPA compression is mainly relieved by surgery.Airway stenosis index and combined complete cartilage ring may be the high risk factors for the children's postoperative death.