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目的:研究肺动脉吊带患儿气管狭窄处直径与患儿预后的关系。方法:回顾性分析2011年10月至2015年7月在重庆医科大学附属儿童医院诊断为肺动脉吊带的病例,分析患儿临床表现、CT成像测量气管狭窄处直径、治疗及预后(存活或死亡)。采用独立样本T检验研究存活组和死亡组患儿气管狭窄直径与预后的关系。结果:发现29例肺动脉吊带患儿,中位数年龄为6月。绝大多数患儿生后反复出现喘息症状。27例患儿进行了增加CT心血管重建+气道重建检查明确了肺动脉吊带诊断及气道畸形情况。2例患儿经心脏彩超诊断肺动脉吊带,并行CT气道重建检查。29例患儿中死亡11例。性别、年龄、气道畸形类型和合并心血管畸形在死亡组和存活组患儿的差异无统计学意义(P值分别为1.000、0.063、0.696和0.671)。死亡组患儿气管狭窄处横径和前后径均明显小于存活组[(2.75±0.56)mm vs.(3.37±0.45)mm;(2.26±0.35)mm vs.(2.70±0.49)mm;P分别为0.003、0.015]。15例患儿行手术治疗,10例手术成功,5例手术后死亡。手术死亡组患儿气管狭窄处横径和前后径均小于手术存活组患儿[(2.85±0.80)mm vs.(3.42±0.29)mm;(2.40±0.50)mm vs.(2.80±0.36)mm,差异无统计学意义(P分别为0.188、0.096]。结论:增强CT心血管重建+气道重建检查除了能明确肺动脉吊带诊断,还可以测定气道狭窄直径,有助于评判患儿预后。气管狭窄的程度可能是决定肺动脉吊带患儿预后的关键。
Objective: To study the relationship between the diameter of tracheal stenosis and the prognosis of children with pulmonary artery stenosis. Methods: The cases diagnosed as pulmonary artery stenosis in Children’s Hospital of Chongqing Medical University from October 2011 to July 2015 were retrospectively analyzed. The clinical manifestations, the diameter of tracheal stenosis at CT imaging, the treatment and prognosis (survival or death) were analyzed. . The independent sample T-test was used to study the relationship between the diameter of tracheal stenosis and prognosis in survivors and deaths. Results: 29 children with pulmonary artery stenosis were found, the median age was 6 months. Most children suffer wheezing repeatedly after birth. Twenty-seven children underwent CT angiography reconstruction and airway reconstruction examination to confirm the diagnosis of pulmonary artery stenosis and airway deformity. Two cases of children with pulmonary artery stenosis by color Doppler ultrasound, parallel CT airway reconstruction examination. Eleven patients died in 29 cases. There were no significant differences in gender, age, airway deformity and cardiovascular malformations between death and survivors (P = 1.000, 0.063, 0.696 and 0.671, respectively). The diameter and anteroposterior diameter of the tracheal stenosis in the death group were significantly lower than those in the survival group [(2.75 ± 0.56) mm vs. (3.37 ± 0.45) mm and (2.26 ± 0.35) mm vs. (2.70 ± 0.49) mm respectively 0.003,0.015]. Fifteen children underwent surgery, 10 were successful, and 5 died after surgery. The diameter and anteroposterior diameter of the tracheal stenosis in the surgical death group were less than those in the surgical survival group [(2.85 ± 0.80) mm vs. (3.42 ± 0.29) mm; (2.40 ± 0.50) mm vs. (2.80 ± 0.36) mm (P = 0.188, 0.096, respectively) .Conclusion: CT angiography and airway reconstruction can not only confirm the diagnosis of pulmonary artery stenosis, but also determine the diameter of airway stenosis, which is helpful to evaluate the prognosis of children. The degree of tracheal stenosis may be the key to determining the prognosis of children with pulmonary artery stenosis.