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超声与CT联合应用 在复杂先天性心脏 病中的诊断价值*

作者:葛先立1 王 战2

所属单位:1.河南省商丘市第三人民医院功能 科 (河南 商丘 476000) 2.河南省郑州市第一人民医院CT室 (河南 郑州 450000)

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摘要

目的 探讨超声与CT联合应用在 复杂先天性心脏病中的诊断价值。方法 选取我院2012年5月-2017年5月收治的复 杂先天性心脏病患者86例为研究对象,均 经手术病理证实,且术前进行超声及CT检 查。比较分析手术诊断与超声、CT以及二 者联合检查诊断结果。结果 本组患者经 手术证实,心脏畸形共有217处,包括心 脏大血管连接处结构异常66处,心内与 房室连接处结构异常112处,心外大血管 结构异常39处。超声检查共检出196处, 诊断准确率为90.32%;CT检查共检出197 处,诊断准确率为90.78%;超声与CT联合 检查共检出211处,诊断准确率97.24%, 二者联合诊断的准确率明显高于单纯超声 及单纯CT诊断准确率,分别比较差异有统 计学意义(P<0.01)。结论 超声和CT在复 杂先天性心脏病诊断中各有优势和不足, 二者联合检查可实现优势互补,显著提高 诊断准确率;同时,该检查方式无明显侵 入性、费用较低,有较高的临床应用价 值。

Objective To explore the diagnostic value of ultrasound and CT in complex congenital heart disease. Methods 86 patients with complex congenital heart disease were selected as the study subjects in our hospital from May 2012 to May 2017, who were confirmed by surgical pathology and preoperative ultrasonography and CT examination were performed. To have a comparative analysis of surgical diagnosis and ultrasonography, CT and the combination of the two diagnostic results, respectively. Results This group of patients confirmed by surgery, a total of 217 heart deformities, the structure of the coronary artery was 66, and the structure of the atrioventricular junction was 112, and the large vascular structure of the heart was 39. Ultrasound detected 196 heart deformities, the diagnostic accuracy rate was 90.32%. CT examination detected 197, the diagnostic accuracy rate was 90.78%; the combined use of ultrasound and CT combined examination detected 211, the diagnostic accuracy rate was 97.24%, the accuracy of the combined diagnosis was significantly higher than that of ultrasound or CT alone, the difference was statistically different (P<0.01). Conclusion Ultrasound and CT in the diagnosis of complex congenital heart disease have their own advantages and disadvantages, the two ways combined can achieve complementary advantages, significantly improve the diagnostic accuracy, at the same time, the inspection method is not invasive, costless, and have high clinical application value.

【关键词】超声;复杂先天性心脏病;诊 断价值

【中图分类号】R445.1;R445.3;R541.1

【文献标识码】A

【DOI】10.3969/j.issn.1672- 5131.2018.02.027

前言

复杂先天性心脏病指伴有≥2种以上畸形的先天性心脏病,该病 具有较高的病死率,严重威胁患者身体健康及生命安全[1]。目前,临 床上针对复杂先天性心脏病患者多给予矫正手术治疗,术前明确诊断 并全面了解畸形状况是评估手术风险的重要依据,同时,术前对患者 进行确定性诊断,掌握其内外畸形的基本形态可为制定手术方案提供 依据,有助于提高临床疗效。研究表明,早期诊断和及时有效治疗是 提高复杂先天性心脏病患者生命质量、改善预后的关键[2]。既往通常 采用超声对复杂先天性心脏病进行诊断,但其应用有一定局限。近年 来,螺旋CT及其血管成像技术迅速发展,其以无创手段可对心血管及 心外解剖结构的畸形进行有效评估,被广泛应用于各种疾病的临床诊 断中。为了进一步探讨超声和螺旋CT在诊断复杂先天性心脏病中的应 用价值,本研究回顾性分析了我院近年收治的经手术病理证实的86例 复杂先天性心脏病患者的临床资料,均在术前进行超声和CT检查,有 完整的影像学诊断资料,现将分析结果汇报如下。