CAJ | 학술논문

A 型主动脉壁间血肿的单中心治疗分析
A 형주동맥벽간혈종적단중심치료분석
Analysis of type A intramural hematoma management strategy in single center

万方数据

心血管外科杂志（电子版）心血管外科雜誌（電子版） 심혈관외과잡지（전자판）
Journal of Cardiovascular Surgery(Electronic Edition)
2014年 2期 74-76 ,共3页

陆华%颜涛%王晓武%马涛%张卫达%于浩%李瑶瑶%王显悦%董文鹏%梅鲁刚%李杰%王晓莉

륙화%안도%왕효무%마도%장위체%우호%리요요%왕현열%동문붕%매로강%리걸%왕효리

主动脉壁间血肿%外科手术%药物疗法%腔内隔绝术主動脈壁間血腫%外科手術%藥物療法%腔內隔絕術
주동맥벽간혈종%외과수술%약물요법%강내격절술
Intramural hematoma%Surgical procedures,operative%Drug therapy%Endovascular therapy

目的总结分析Standford A型主动脉壁间血肿患者诊疗经验及结果，探索Standford A型主动脉壁间血肿患者的治疗方法及时机。方法回顾性分析我院在2011年1月至2014年4月收治的急性主动脉综合征204例，其中Standford A型主动脉壁间血肿患者12例，男10例，女2例，年龄38～62岁。12例中，急诊手术3例，9例采取非手术治疗。结果急诊手术3例行升主动脉置换术，术后痊愈出院。非手术治疗中，2例痊愈，3例转为A型夹层（2例行全弓置换术，1例死亡）；剩余4例因弓降部溃疡行腔内隔绝术，2例痊愈，剩余2例分别在术中及随访中出现夹层。结论 A型主动脉壁间血肿是个动态发展的疾病，有血肿吸收痊愈的可能，但大部分患者在血肿吸收过程中有出现病情进一步加重的可能。因此，在边药物治疗边观察的同时应做好随时手术治疗的准备。
목적총결분석Standford A형주동맥벽간혈종환자진료경험급결과，탐색Standford A형주동맥벽간혈종환자적치료방법급시궤。방법회고성분석아원재2011년1월지2014년4월수치적급성주동맥종합정204례，기중Standford A형주동맥벽간혈종환자12례，남10례，녀2례，년령38～62세。12례중，급진수술3례，9례채취비수술치료。결과급진수술3례행승주동맥치환술，술후전유출원。비수술치료중，2례전유，3례전위A형협층（2례행전궁치환술，1례사망）；잉여4례인궁강부궤양행강내격절술，2례전유，잉여2례분별재술중급수방중출현협층。결론 A형주동맥벽간혈종시개동태발전적질병，유혈종흡수전유적가능，단대부분환자재혈종흡수과정중유출현병정진일보가중적가능。인차，재변약물치료변관찰적동시응주호수시수술치료적준비。
Objective To summarize the experience of treatment of acute type A intramural hematoma ( IMH) ,exploring the best management method for acute type A IMH .Methods Between January 2011 and April 2014,204 patients with acute aortic syndrome were treated ,including 12 with type A IMH.Three IMH patients were repaired immediately , the remain nine patients managed initially with optimal medical management . Results Ascending aortic replacement was undertaken in the three emergency surgery ,with fully recovery.Two(2/9 ) medically managed patients survived with resolution of the IMH .Conversion to type A IMH to typical dissection occurred in 33.3%(3/9)of cases(2 total aortic arch replacement,1 death).Endovascular therapy was performed in 44.4%(4/9) IMH patients who develop newly aortic ulcer , with 2 conversion to typical dissection and 2 fully recovery .Conclusions Given the dynamic evolution of acute type A IMH and the resolution possibility of IMH ,the proper strategy maybe‘wait and see ’ with surgery preparation .