Vascular rings: a rare cause of common respiratory symptoms
Vascular rings: a rare cause of common respiratory symptoms
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DOI：
10.1080/08035259950168423
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发表时间：
1999-09-01
期刊：
影响因子：
3.8
通讯作者：
Bogers, AJJC
中科院分区：
文献类型：
--
作者：
Bakker, DAH;Berger, RMF;Bogers, AJJC
上呼吸道症状或吞咽困难可能是由血管异常引起的，在气管和/或食道周围形成环状。为了分析其临床表现、各种诊断技术的使用、治疗和随访，我们对1981年至1996年间诊断为血管环的38名儿童进行了回顾性研究。我们发现74%的血管环有症状，主要症状是吸气颤动和喘息。在无相关异常的患者中，从出现症状到诊断血管环的延迟时间从1到84个月不等。合并畸形占53%，其中80%为合并心血管畸形。当怀疑有血管环时，食道造影被证明是一项有价值的诊断技术。超声心动图似乎对血管环的诊断价值不大，但对于排除相关的心血管畸形是必不可少的。尽管血管造影术一直被认为是确定血管环精确解剖的金标准，但越来越多的证据表明，CT扫描或MRI可能取代这一作用。5/6例患者的病死率与合并气管畸形有关。在其余的术前有症状的患者中，43%的患者术后症状立即缓解，57%的患者术后4年内症状缓解。婴儿期或儿童期长期反复出现的呼吸主诉或吞咽困难应提醒儿科医生注意血管环的可能性。
Upper airway symptoms or dysphagia may be caused by vascular anomalies, forming a ring around the trachea, oesophagus or both. To analyse the clinical presentation, use of various diagnostic techniques, treatment and follow-up we carried out a retrospective study of 38 children who had been diagnosed with a vascular ring between 1981 and 1996. We found 74% of the vascular rings to be symptomatic, with inspiratory strider and wheezing as the main complaints. The delay between the onset of symptoms and diagnosis of a vascular ring in patients without associated anomalies ranged from 1 to 84 mo. Associated anomalies were found in 53% of cases and 80% of these anomalies consisted of associated cardiovascular malformations. Oesophagography proved to be a valuable diagnostic technique when a vascular ring was suspected. Echocardiography appeared to be of little value for the diagnosis of a vascular ring, but was essential to exclude associated cardiovascular malformations. Although angiography has always been considered to be the gold standard in the determination of the exact anatomy of vascular rings, increasing evidence is available that CT scan or MRI may replace this role. Mortality was related to co-existent tracheal deformities in 5/6 cases. Of the remaining, preoperatively symptomatic patients, relief of symptoms was achieved immediately after surgery in 43% and within 4y after surgery in 57%. Prolonged and recurrent respiratory complaints or dysphagia in infancy or childhood should alert the paediatrician to the possibility of a vascular ring.