64层螺旋CT对儿童漏斗胸的心脏及小气道改变的评价

目的:通过CT观察儿童漏斗胸心脏形态及小气道改变,探讨胸廓畸形程度对心脏形态、小气道改变的影响及64层螺旋CT的价值。方法:搜集2009～2011年临床确诊漏斗胸并行胸部64层螺旋CT三维重建检查的患儿183例,测量胸廓的Haller指数、心脏旋转角度,在MPR肺窗上观察小气道改变。按Haller指数将病例分为轻、中、重度3组,比较3组间心脏旋转角、小气道改变的差异性,探讨胸骨凹陷程度对两者的影响。结果:183例漏斗胸患儿分为轻度54例(Haller指数2.86±0.31)、中度22例(3.36±0.10)、重度107例(4.61±1.27),三者间差异有统计学意义(P<0.05)。心脏旋转角分别为55.52°±8.76°、57.38°±5.03°和65.93°±7.67°,三者间差异有统计学意义(P<0.05)。随凹陷程度的增加,心脏旋转角也增加,二者有相关性(r=0.596,P<0.05)。60例患儿有小气道改变,轻、中、重度分别占22.22%(12/54)、22.73%(5/22)、40.19%(43/107),3组之间差异有统计学意义(P<0.05)。其中53例有左肺下叶小气道的改变。结论:64层螺旋CT可准确显示漏斗胸的胸廓畸形程度、心脏受压旋转及小气道改变。随着胸廓凹陷程度的加重,心脏旋转角及小气道改变也增加。

The evaluation of the cardiac and small airway changes in pectus excavatum of children with 64-slice computed tomography

Objective：Through the retrospective research of cardiac rotation and small airway changes in pectus excavatum,we investigate the effect of the degree of sternal depression on them and the value of the 64-slice CT.Methods：64-slice CT and three-dimensional reconstruction features of pectus excavatum proved clinically 183 cases between 2009 and 2011 were retrospectively reviewed.Measured the Haller index,cardiac rotation angle on axial CT images of the chest,researched the small airway changes on MPR lung-window.Haller index was used as standard to classify the cases to three grades,analysed differences between the three grades on cardiac angle,small airway changes,and investigated the effect of the degree of sternal depression on them.Results：183 cases were classified into three grades：mid-grade：54 cases（2.86±0.31）,middle-grade：22cases（3.36 ±0.10）,high-grade：107case（4.61±1.27）.The three grades were significant different（P〈0.05）.The cardiac rotation angle of the three grades were 55.52°±8.76°,57.38°±5.03°,65.93°±7.67°,there were significant difference among them（P〈0.05）.60 cases had small airway changes,the morbidity of the three grades were 22.22%（12/54）、22.73%（5/22）、40.19%（43/107）,there were significant difference among the three grades（P〈0.05）. 53 cases among them had lobus pulmonis sinister small airway changes.Conclusion：The 64-slice CT is a better tool for revealing chest deformity,cardiac rotation and small airway changes of pectus excavatum.As the degree of chest deformity increase,the cardiac rotation angle,morbidities of small airway changes increases,the three exist positive correclation.