Drucker D E, Greenfield L J, Ehrlich F, Salzberg A M
J Pediatr Surg. 1986 Aug;21(8):725-30. doi: 10.1016/s0022-3468(86)80397-9.
Aneurysms of the aorta and its major branches are rare in the pediatric population and are usually associated with cardiovascular malformations. Recently, however, a number of children have emerged with aneurysms following umbilical artery catheterization (UAC). In the last 8 years, two such patients have presented at the Medical College of Virginia. These are reported in detail and compared with 18 others found in the literature (12 thoracic, 4 abdominal, 2 iliac). Several conclusions follow from the study of this group of 20 children: The history of umbilical artery catheterization in the presence of bacteremia, especially staphylococcal, is a prime risk factor in the development of aneurysms (90%, P less than .01). In addition, there was a concordance between the location of the catheter tip and the site of future aneurysm formation (P less than .05). UAC associated aneurysms are difficult to diagnose because of their rarity and have often been mistaken for tumors. The diagnosis should be suspected in the workup of a tumor in a child with an appropriate history. Though these aneurysms are probably mycotic, pus has not been encountered at surgery and there have been no reported graft infections. Patients with S aureus bacteremia complicating UAC should be followed closely to detect aneurysm formation.
主动脉及其主要分支的动脉瘤在儿科人群中较为罕见，通常与心血管畸形相关。然而，最近出现了一些在脐动脉插管（UAC）后发生动脉瘤的儿童。在过去8年中，弗吉尼亚医学院收治了2例此类患者。本文将对这2例患者进行详细报道，并与文献中发现的其他18例患者（12例胸段、4例腹段、2例髂段）进行比较。对这组20名儿童的研究得出了几个结论：在存在菌血症，尤其是葡萄球菌菌血症的情况下进行脐动脉插管是动脉瘤形成的主要危险因素（90%，P<0.01）。此外，导管尖端位置与未来动脉瘤形成部位之间存在一致性（P<0.05）。与UAC相关的动脉瘤因其罕见而难以诊断，常被误诊为肿瘤。对于有适当病史的儿童肿瘤检查，应怀疑有此诊断。尽管这些动脉瘤可能是霉菌性的，但手术中未发现脓液，也没有报道过移植物感染。合并UAC的金黄色葡萄球菌菌血症患者应密切随访以检测动脉瘤形成。
