CAJ | 학술논문

目的：分析先天性复杂心脏病双向 Glenn 术后患者出现咯血的原因。方法回顾性分析24例本院行双向 Glenn 术患者的影像学资料，其中男16例，女8例，年龄3~27岁。病种组成为单心室14例，三尖瓣闭锁3例，肺动脉闭锁4例，右室双出口3例。结果术后数年6例患者出现不同程度咯血，量约50~300 mL。除1例患者有左肺下叶支气管扩张外，其余5例患者经影像学检查发现肺部出现云雾状磨玻璃高密度影，且在相应的肺段发现1处或1处以上的肺动静脉瘘，病灶均位于肺外围(胸膜下)，经治疗后短期内肺部磨玻璃密度影消失或明显好转，高度提示肺动静脉瘘形成并肺出血。其中3例经介入栓塞，咯血停止；1例因出血量不大，瘘口较小，经保守治疗好转出院。1例因左肺下叶弥漫性肺动静脉瘘需行肺叶切除，患者暂拒绝手术，对症处理好转出院。统计本组术后患者肺动静脉瘘的发生率约为20.8%，与文献报道基本一致(25%)。结论复杂先天性心脏病患者行双向Glenn 术数年后，如果出现不明原因的咯血，在除外肺结核、支气管扩张等原发肺部疾患，以及大的体肺侧支血管破裂等因素后，需要特别警惕有无肺动静脉瘘形成的可能，肺血管多排螺旋 CT 检查可确诊，特别在肺出血相应肺段仔细寻找，轴位辅以冠状位、矢状位多平面成像，为临床治疗提供准确、及时的依据。
목적：분석선천성복잡심장병쌍향 Glenn 술후환자출현각혈적원인。방법회고성분석24례본원행쌍향 Glenn 술환자적영상학자료，기중남16례，녀8례，년령3~27세。병충조성위단심실14례，삼첨판폐쇄3례，폐동맥폐쇄4례，우실쌍출구3례。결과술후수년6례환자출현불동정도각혈，량약50~300 mL。제1례환자유좌폐하협지기관확장외，기여5례환자경영상학검사발현폐부출현운무상마파리고밀도영，차재상응적폐단발현1처혹1처이상적폐동정맥루，병조균위우폐외위(흉막하)，경치료후단기내폐부마파리밀도영소실혹명현호전，고도제시폐동정맥루형성병폐출혈。기중3례경개입전새，각혈정지；1례인출혈량불대，루구교소，경보수치료호전출원。1례인좌폐하협미만성폐동정맥루수행폐협절제，환자잠거절수술，대증처리호전출원。통계본조술후환자폐동정맥루적발생솔약위20.8%，여문헌보도기본일치(25%)。결론복잡선천성심장병환자행쌍향Glenn 술수년후，여과출현불명원인적각혈，재제외폐결핵、지기관확장등원발폐부질환，이급대적체폐측지혈관파렬등인소후，수요특별경척유무폐동정맥루형성적가능，폐혈관다배라선 CT 검사가학진，특별재폐출혈상응폐단자세심조，축위보이관상위、시상위다평면성상，위림상치료제공준학、급시적의거。
Objective To analyze the reason of hemoptysis after the bidirectional Glenn shunt procedure on complex congenital heart disease.Methods The feature of imaging data of 24 patients (1 6 males,8 females;age ranges:3-27 years;14 cases of single ventricle,3 cases of tricuspid Atresia,4 cases of pulmonary Atresia,3 cases of double Outlet Right Ventricle)after the bi-directional Glenn shunt procedure were retrospectively studied.Results Six patients had various degrees of hemoptysis (50 - 300 mL)after surgery,except for one case which has bronchiectasis on the left inferior lobe.The common feature of the other 5 cases present as plaque ground glass opacity and pulmonary arteriovenous fistula located at the corresponding subpleural field.After different therapy (three cases were performed endovascular management,2 cases were under expectant treatment),the lesion disappeared or obviously smaller which was clear evidence for the existence and bleeding of fistula.The occurrence of this disease in the present study was nearly 20.8%,which were accord with references.Conclusion Pulmonary arteriovenous fistula should be considered when crypto-genic hemoptysis happened after bi-directional Glenn shunt with complex congenital heart disease which exclude tuberculosis,bron-chiectasis or rupture and bleeding of MAPCAs.Multiple sliced CT angiography can be used to as the first line examination and sup-ply acute evidence for clinic therapy in time.