儿童缩窄性心包炎78例病例系列报告

目的:分析儿童缩窄性心包炎(CP)的临床特征、诊治及预后,以提高对该病的诊治水平。方法:纳入1996年1月1日至2018年1月1日在重庆医科大学附属儿童医院住院、确诊为CP的患儿。从电子病历系统中截取患儿的一般资料、首发症状及体征、病因、误诊情况、影像学检查、术中发现、病理活检、治疗和预后资料。结果:78例CP患儿进入本文分析,男49例,平均年龄9.4(1~15.4)岁,平均病程13.4个月(6d至7年)。病前有结核病接触史6例(7.7%),病前无明确急性心包炎病史41例(52.6%)。首发症状以水肿(61/78,78.2%)、体征以肝脏肿大(72/78,92.3%)最多见。病因不明30例(38.4%),病因明确者以肺吸虫感染(19例,24.4%)为主。20例(25.6%)误诊为其他疾病。55/78例(70.5%)X线胸片提示CP,45/48例(93.8%)胸透提示CP,31例(100%)胸部及心脏CT和1例(100%)心脏MRI均提示CP,72/78例(92.3%)超声心动图检查提示CP。61例(78.2%)行手术治疗,术中发现心包厚薄不均。60/61例手术患儿行病理活检,心包增厚59例(98.3%),心包厚度正常1例(1.7%)。病理提示非特异性CP48例(80.0%),结核性心包炎6例(10.0%),化脓性心包炎4例(6.7%),肺吸虫性心包炎2例(3.3%)。61例手术患儿中,60例好转出院,1例死亡。17例放弃手术治疗,其中7例失访,电话随访10例死亡。结论:CP病因大多不明确,病因以肺吸虫为主。儿童CP误诊率较高。病理活检对明确病因特异性不高,超声心动图为诊断CP的首选检查。心包剥脱术是治疗CP的最佳手术方式,预后较好。

Clinical analysis of 78 children with constrictive pericarditis

ObjectiveIn order to improve the diagnosis and treatment of constrictive pericarditis (CP) in children by analyzing the etiology, misdiagnostic causes,clinical manifestations, diagnosis,treatment and prognosis of the disease.Methods From January 1996 to January 2018, 78 patients with confirmed CP were enrolled. Data on clinical characteristics, disease manifestations, treatment, and outcomes were collected and analyzed.Results Seventy-eight patients with CP were enrolled. There were 49 males with an average age of 9.4 (1 to 15.4) years and an average duration of 13.4 months (6 days to 7 years). There were 6 cases (7.7%) with history of tuberculosis before the disease, and there were 41 cases (52.6%) with no clear history of acute pericarditis. The first symptom was edema (61/78, 78.2%), and the most common sign was hepatomegaly (72/78, 92.3%). The etiology was unclear in 30 cases (38.4%). The main cause was paragonimiasis infection (19 cases, 24.4%) in patients with clear etiology. Twenty cases (25.6%) were misdiagnosed as other diseases. The positive rate of chest radiography was 70.5%(55/78); chest perspective was 92.3%(45/48); cardiac CT was 100% (31 /31); cardiac MRI was 100%(1/1), and echocardiography was 92.3%(72 /78). Sixty-one patients (78.2%) underwent surgery and were found that the pericardium was uneven. Pathological biopsy was performed in 60/61 surgical patients, with pericardial thickening in 59 cases (98.3%) and normalpericardial thickness in 1 case (1.7%). Pathological examination showed there were 48 cases of non-specific CP (80.0%), 6 cases of tuberculous pericarditis (10.0%), 4 cases of suppurative pericarditis (6.7%), and 2 cases of paragonimal pericarditis (3.3%). Of the 61 surgical patients, 60 were discharged and one died. Seventeen patients gave up surgery, 7 of whom lost contact, and 10 were dead.Conclusion Most of CP were of unknown cause, but in known causes paragonimiasis had a high incidence. The misdiagnosis rate of pediatric CP was high. Docters' better understanding of CP may reduce misdiagnosis. Pathological biopsy had low specificity in determining etiology. Echocardiography was still the first choice for the diagnosis of CP. Pericardial stripping is considered the best surgical procedure in the treatment of CP, and the prognosis is good.