本文選題：心臟缺損 + 先天性�。� 參考：《廣州醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的探討復(fù)雜型先天性心臟�。ㄏ刃牟。┗純捍笮椭�-肺動(dòng)脈側(cè)支血管（majoraortopulmonary collateral arteries, MAPCAs）的形態(tài)學(xué)特征。方法回顧性分析伴MAPCAs的復(fù)雜型先心病患兒的MAPCAs的影像學(xué)資料，總結(jié)MAPCAs發(fā)布規(guī)律、數(shù)量及形態(tài)學(xué)特征。結(jié)果本組伴MAPCAs的復(fù)雜型先心病患兒51例，其中肺動(dòng)脈閉鎖/室間隔缺損33例（64.71%），法洛四聯(lián)癥11例（21.57%），右室雙出口2例（3.92%），完全性大動(dòng)脈轉(zhuǎn)位1例（1.96%），完全性房室間隔缺損1例（1.96%），肺動(dòng)脈狹窄1例（1.96%），肺動(dòng)脈吊帶1例（1.96%），肺動(dòng)脈缺如1例（1.96%）。另外，合并動(dòng)脈導(dǎo)管未閉16例（31.37%）。本組51例中存在中央共匯43例（84.31%），MAPCAs共117支，每例約1~6支，平均2.29支。MAPCAs起始直徑為2.0~18.0mm，平均約4.3mm。MAPCAs起源于主動(dòng)脈弓16支（13.68%），胸降主動(dòng)脈75支（64.10%），頭臂干2支（1.71%），右鎖骨下動(dòng)脈11支（9.40%），左鎖骨下動(dòng)脈12支（10.26%），其他1支（0.85％）。本組有3支（2.56%）MAPCAs開口出現(xiàn)狹窄及狹窄后擴(kuò)張，，57支（48.72%）MAPCAs在進(jìn)入肺臟前出現(xiàn)迂回、扭曲狀，8例（15.69%）患兒MAPCAs為唯一血源供應(yīng)相應(yīng)肺段。另有13支（11例，均為肺動(dòng)脈閉鎖/室間隔缺損）較粗大的MAPCAs可見分支，其分支為2~4支，多為2支。根據(jù)Rabinovitch等對(duì)MAPCAs的分型，可見本組病例中，Ⅱ型有91支(77.78%)，Ⅲ型有26支(22.22%)，未見Ⅰ型。結(jié)論MAPCAs多見于某些肺血減少型先心病，且分布較廣泛，其起源、數(shù)量、大小、走向以及分支等方面變異較大，主要影響手術(shù)方式選擇及療效，了解MAPCAs的分布規(guī)律及形態(tài)學(xué)特征具有十分重要的臨床意義。
[Abstract]:Objective to investigate the morphological characteristics of majoraortopulmonary collateral arteries (MAPCAs) in children with complex congenital heart disease (congenital heart disease). Methods the imaging data of MAPCAs in children with complex congenital heart disease with MAPCAs were retrospectively analyzed, and the regularity of MAPCAs publication, quantitative and morphological characteristics were summarized. There were 51 children with complex congenital heart disease with MAPCAs, including 33 cases of pulmonary atresia / ventricular septal defect (64.71%), 11 (21.57%) tetralogy of Fallot, 2 right ventricle double exit (3.92%), 1 complete transposition of the large artery (1.96%), 1 cases of complete atrioventricular septal defect (1.96%), pulmonary artery stenosis 1 (1.96%), pulmonary artery sling in 1 cases, pulmonary artery absent In addition, 16 cases (31.37%) were combined with patent ductus arteriosus (31.37%). In this group, there were 43 cases of Central Co remittance (84.31%), 117 MAPCAs, each 1~6 branch, and the average initial diameter of 2.29.MAPCAs was 2.0~18.0mm. The average about 4.3mm.MAPCAs originated from the 16 branch of the aortic arch (13.68%), the thoracic aorta 75 (64.10%), the cephalosbrachial 2 branches (1.71%), and right clavicle. 11 arteries (9.40%), 12 branches of left subclavian artery (10.26%) and 1 (0.85%). 3 (2.56%) MAPCAs openings were narrowed and dilated after stenosis. 57 (48.72%) MAPCAs appeared to be tortuous and twisted before entering the lungs. In 8 (15.69%) children, MAPCAs served as the sole source of the pulmonary artery. Another 13 (all were pulmonary atresia / interventricular). Septal defect) a larger branch of MAPCAs, with a branch of 2~4 branch and more than 2 branches. According to the classification of MAPCAs by Rabinovitch, there are 91 (77.78%), 26 (22.22%) type of type II in this group, and no type I. Conclusion MAPCAs is mostly found in certain pulmonary blood reduction type of congenital heart disease and is widely distributed, its origin, quantity, size, trend and trend. The variation of branches and other factors mainly affect the choice and curative effect of operation. It is of great clinical significance to understand the distribution and morphological characteristics of MAPCAs.
【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R725.4

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