目的 评价彩色多普勒超声心动图对先天性血管环(CVR)的诊断价值,分析超声心动图漏诊的原因,旨在提高其对CVR诊断的准确率.方法 回顾性分析103例经外科手术证实为CVR患儿的经胸超声心动图资料,以手术结果为标准,与手术、CTA对比分析其声像图特点.结果 103例CVR构成类型:肺动脉吊带61例,超声心动图诊断准确率96.7％ (59/61),漏诊率3.3％ (2/61);双主动脉弓21例,超声心动图准确率57.1％ (12/21),漏诊率42.9％ (9/21);右位主动脉弓伴迷走左锁骨下动脉19例,超声心动图诊断准确率15.8％ (3/19),漏诊率84.2％ (16/19),左位主动脉弓伴迷走右锁骨下动脉2例,上述血管环畸形CTA全部诊断.103例CVR中伴有心内畸形77例,超声心动图全部诊断,而CTA漏误诊率11.7％ (9/77).结论 超声心动图对于诊断肺动脉吊带及心内畸形的灵敏度高,但对双主动脉弓及迷走锁骨下动脉畸形易漏诊;与CTA结合能更好地明确血管环病变的组成及气管形态异常,为手术计划提供完整的信息.%Objective To evaluate and analyze echocardiography(ECG) in diagnosis of congenital vascular rings (CVR) to elevate accuracy of diagnosis.Methods 103 cases of children with CVR confirmed by surgery were analyzed retrospectively.We reviewed the ECG and CTA characteristics of this disease with the surgical results as the gold standard.Results Among the 103 CVR patients,61 cases were pulmonary artery sling (PAS),ECG sensitivity was 96.7 ％ (59/61),missed diagnosis rate was 3.3 ％ (2/61).21 cases were double aortic arch(DAA),ECG sensitivity was 57.1％ (12/21),missed diagnosis rate was 42.9 ％ (9/21).19 cases were right aortic arch with an aberrant left subclavian artery(RAA-ALSA),ECG sensitivity was 15.8％(3/19),missed diagnosis rate was 84.2％ (16/19).2 cases were left aortic arch with aberrant right subclavian artery(LAA-ARSA).All the CVR cases were diagnosed by CTA.77 CVR combined with intracardiac malformation and all diagnosed byECG and the missed diagnosis rate was 11.7 ％ for CTA.Conclusions Missed diagnosis are prone to take place in DAA and an aberrant subclavian artery than in PAS with ECG.CTA could show clearly the relationship of vascular rings and trachea.So integration of the two diagnosis methods could hand out more information to operation plan.
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