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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 investigate the diagnosis and treatment of vascular rings and airway pressure in infants and newborns. Methods From June 2004 to December 2009, 16 cases of infants and newborn infants (7 males and 9 females, aged 1 to 12 months) were admitted to Guangdong Provincial People’s Hospital. 13 cases and intracardiac deformity. Children underwent chest radiography, echocardiography and spiral CT examination, of which 9 cases were diagnosed by fiberoptic bronchoscopy. Fifteen patients underwent cardiopulmonary bypass with cardiopulmonary bypass. One case underwent revascularization and pericardial patch expansion. Eleven cases of intra-cardiac deformity were treated simultaneously. Results Pulmonary artery sling in 5 cases (including 1 case with tracheal ring), right aortic arch / left ligament or vagus left subclavian artery in 8 cases, double aortic arch in 1 case, unnamed arterial compression syndrome in 1 case, pulmonary sling, left aortic arch / Vagus left subclavian artery formation of two vascular rings and tracheal ring in 1 case. Echocardiography missed diagnosis in 9 cases. 16 cases of CT examination were diagnosed as vascular ring. Fiber bronchoscopy shows tracheal compression. Among them, 14 cases were cured or symptoms disappeared, and 2 cases died of tracheal ring. Eleven patients were followed up, of which 5 patients still had mild wheezing episodes after operation. Conclusion Infantile and neonatal vascular rings and airway pressure often show shortness of breath, wheezing and dyspnea. Spiral CT plays an important role in the diagnosis and treatment of the disease. Circulation of the loop can relieve respiratory pressure, tracheal stenosis should be at the same time tracheoplasty.