CAJ | 학술논문

目的：探讨病变段主动脉壁有钙化斑的 Stanford B 型主动脉壁间血肿患者的治疗方案。方法2009年3月-2012年3月收治15例主动脉壁有钙化斑的 Stanford B 型主动脉壁间血肿患者，均经64排 CTA 全主动脉扫描确诊病变段。15例患者死亡1例，7例行主动脉腔内修复术（TEVAR），7例全程保守治疗，并进行1年随访，在3、6个月及1年时复查主动脉 CTA。结果21例中1例入院后停止服用长期使用的抗血小板药物，突发心肌梗死死亡。7例 TEVAR 治疗和7例严格药物保守治疗患者，均无症状出院。失访1例，随访13例，于发病3、6、12个月复查主动脉 CTA，壁间血肿均逐渐减少或吸收，无症状复发患者。结论病变段主动脉壁有钙化斑的 Stanford B 型主动脉壁间血肿患者治疗的关键是防止其恶化，在严格保守治疗的同时，对需长期口服抗凝抗血小板药物者、严格保守治疗过程中症状不缓解者、症状缓解后复发者、定期影像学检查壁间血肿或（和）主动脉穿透性溃疡进展者要及时行 TEVAR 治疗。
목적：탐토병변단주동맥벽유개화반적 Stanford B 형주동맥벽간혈종환자적치료방안。방법2009년3월-2012년3월수치15례주동맥벽유개화반적 Stanford B 형주동맥벽간혈종환자，균경64배 CTA 전주동맥소묘학진병변단。15례환자사망1례，7례행주동맥강내수복술（TEVAR），7례전정보수치료，병진행1년수방，재3、6개월급1년시복사주동맥 CTA。결과21례중1례입원후정지복용장기사용적항혈소판약물，돌발심기경사사망。7례 TEVAR 치료화7례엄격약물보수치료환자，균무증상출원。실방1례，수방13례，우발병3、6、12개월복사주동맥 CTA，벽간혈종균축점감소혹흡수，무증상복발환자。결론병변단주동맥벽유개화반적 Stanford B 형주동맥벽간혈종환자치료적관건시방지기악화，재엄격보수치료적동시，대수장기구복항응항혈소판약물자、엄격보수치료과정중증상불완해자、증상완해후복발자、정기영상학검사벽간혈종혹（화）주동맥천투성궤양진전자요급시행 TEVAR 치료。
Objective To investigate the suitable therapeutic schedule for Stanford B aortic intramural hematoma associated with calcification. Methods During the period from March 2009 to March 2012, a total of 15 patients of Stanford B aortic intramural hematoma with calcified plaque were admitted to authors’ hospital. The diagnosis was proved in all patients by CT angiography of the entire aorta with a 64-row CT scanner. Of the 15 patients, death occurred in one, thoracic endovascular aortic repair (TEVAR) treatment was adopted in 7 and conservative therapy was carried out in 7. All the patients were followed up for one year. CT angiography was employed at 3, 6 and 12 months after the treatment to evaluate the therapeutic results. Results One patient died of acute myocardial infarction after admission to hospital when the long-tem use of antiplatelet drugs was stopped. Seven patients received TEVAR treatment and the remaining 7 patients were treated with strict conservative therapy, and all these patients were asymptomatic at the time of discharge. During the follow- up period, CT angiography performed at 3, 6 and 12 months after the treatment showed that the intramural hematoma lesions gradually shrank or were absorbed in 13 patients, and the patients were asymptomatic. The remaining one patient was lost in touch. Conclusion The key to treat Stanford B aortic intramural hematoma with calcification is to prevent deterioration of the lesion. While strict conservative treatment is kept on, TEVAR should be promptly carried out for patients who need to take antiplatelet drugs over a long period of time, for patients whose clinical symptoms are not improved, for patients in whom the relived symptoms recur, and for patients whose CT angiography shows that the penetrating aortic ulcer becomes worse.