部分肺静脉异位引流畸形的漏诊原因分析

目的：分析部分肺静脉引流（ＰＡＰＶＤ）的漏诊原因，以提高术前的准确率和防止手术失误，方法：回顾性分析自１９９１年１月至１９９９年１０月经手述评上实的ＰＡＰＶＤ１５例临床资料与手术结果，找出临床漏诊的原因。结果：本组１５例ＰＡＰＶＤ手术前仅１例诊断明确，漏诊１３例，术中失误１例。１５例术中均见伴有房间隔缺损（ＡＳＤ），并肺动脉瓣狭窄３例，肺动脉高压３例，畸莆引流的部分以右房为最多，其次是上腔静脉，畸形引流的肺静脉以右肺静脉最常见，ＰＡＰＶＤ临床漏诊的主要原因：一是此病常伴有ＡＳＤ，临床上ＰＡＰＶＤ较难与单纯ＡＳＤ相鉴别，二是术前心脏起超检查很易漏诊，三是常见的，简单的心脏畸表手术中为有常规心内探查而造成漏诊，结论：ＰＡＰＶＤ较少见，但漏诊率高，对该病加深认识，提高警惕是防止漏诊的关键。ＭＲＩ对肺静脉异位引流有较大

Causes of missed diagnosis of partial anomalous pulmonary venous drainage

Objective To discuss the results of missed diagnosis or misdiagnosis of partial anomalous pulmonary venous drainage (PAPVD), increase the accuracy of preoperative diagnosis and prevent fault of operation. Methods From Jan. 1991 to Oct. 1995 15 patients with PAPVD received operation in our hospital. The clinical and operation data of them were analyzed to find the reason of missed diagnosis. Result Only 1 out 15 PAPVD patients got a clear diagnosis before operation, 13 were miss diagnosed, 1 was fault operation. All of them were complicated with atrial septal defect (ASD), 3 were complicated with pulmonary stenosis and 3 with pulmonary hypertension. Most anomalous venous were right pulmonary vein, and mostly drain to right atrium and superior vena cave. The causes of missed diagnosis for this disease were the following: ①PAPVD was often complicated with atrial septal defect. It was difficult to identify PAPVD from simple ASD. ②Preoperative UCG examination was often missed diagnosed.③ A closed intracardiacexploration was not routinely performed in the commonand simple operation of congenital heart disease. Conclusion PAPVD was not seen frequently. But it had a high rate of missed diagnosis. Doctors should be aware of this disease. This is the key to prevent missed diagnosis. MRI has a high diagnostic value to this disease.