CAJ | 학술논문

目的回顾孕期主动脉疾病病例,探讨孕期主动脉疾病的临床特点和治疗策略及效果.方法 2005年5月至2014年4月,收治10例孕期主动脉疾病患者,年龄(30.4±4.4)岁,身高(170.7±8.8) cm,体质量(66.7±10.9)kg,身高体质量指数(22.8±3.2) kg/m2.术前超声心动图和主动脉CTA显示Stanford A型主动脉夹层3例,合并马方综合征、高血压和累及右侧冠状动脉开口各1例,孙立忠细化分型均为A2C型;Stanford B型主动脉夹层4例,合并马方综合征1例,高血压病2例,累及全胸腹主动脉1例,孙立忠细化分型B1S型3例,B3C型1例;主动脉根部瘤2例;主动脉根部瘤合并Stanford B型主动脉夹层1例,细化分型为B1C型.根据具体分型及患者临床特点,分别给予保守治疗、主动脉腔内修复治疗和外科手术治疗,分别在术前、术中或术后行剖宫孕及引产术.结果术后死亡2例,均为A2C型主动脉夹层患者,行Bentall加孙氏手术后死于多脏器功能衰竭.其余患者康复出院.2例在本次入院前行剖宫产,1例在主动脉手术的同时行剖宫产,1例主动脉术后行剖宫产,胎儿均生存,1例术后继续妊娠.4例在主动脉手术前行剖宫取胎或人工流产手术,1例在主动脉手术的同时行剖宫取胎术,胎儿均死亡.结论孕期主动脉疾病治疗策略包括药物治疗、腔内修复治疗和外科手术治疗,各种治疗适应证需要根据孕期临床状况综合判断,其中Stanford A型主动脉夹层的预后最差.胎儿的处理需要根据孕周和主动脉疾病的严重程度进行选择.
목적 회고잉기주동맥질병병례,탐토잉기주동맥질병적림상특점화치료책략급효과.방법 2005년5월지2014년4월,수치10례잉기주동맥질병환자,년령(30.4±4.4)세,신고(170.7±8.8) cm,체질량(66.7±10.9)kg,신고체질량지수(22.8±3.2) kg/m2.술전초성심동도화주동맥CTA현시Stanford A형주동맥협층3례,합병마방종합정、고혈압화루급우측관상동맥개구각1례,손립충세화분형균위A2C형;Stanford B형주동맥협층4례,합병마방종합정1례,고혈압병2례,루급전흉복주동맥1례,손립충세화분형B1S형3례,B3C형1례;주동맥근부류2례;주동맥근부류합병Stanford B형주동맥협층1례,세화분형위B1C형.근거구체분형급환자림상특점,분별급여보수치료、주동맥강내수복치료화외과수술치료,분별재술전、술중혹술후행부궁잉급인산술.결과 술후사망2례,균위A2C형주동맥협층환자,행Bentall가손씨수술후사우다장기공능쇠갈.기여환자강복출원.2례재본차입원전행부궁산,1례재주동맥수술적동시행부궁산,1례주동맥술후행부궁산,태인균생존,1례술후계속임신.4례재주동맥수술전행부궁취태혹인공유산수술,1례재주동맥수술적동시행부궁취태술,태인균사망.결론 잉기주동맥질병치료책략포괄약물치료、강내수복치료화외과수술치료,각충치료괄응증수요근거잉기림상상황종합판단,기중Stanford A형주동맥협층적예후최차.태인적처리수요근거잉주화주동맥질병적엄중정도진행선택.
Objective To explore the clinical features,treatment strategies and outcomes of patients with aortic diseases during pregnancy.Methods There were 10 pregnant patients with aortic disease admitted by Beijing Anzhen Hospital from May 2005 to April 2014,Aged (30.4 ± 4.4) years old,height was (170.7 ± 8.8) cm,weight was (66.7 ± 10.9) kg,body mass index was (22.8 ± 3.2) kg/m2.Preoperative echocardiography and aortic CTA showed that 3 patients with Stanford type A aortic dissection,4 patients with simply Stanford type B aortic dissection; 2 patients with pure aortic root aneurysm; 1 patient with aortic root tumor merger Stanford type B aortic dissection.In the patients with Stanford type A aortic dissection,1 patient combined with Marfan syndrome,1 patient combined with hypertension and 1 patient' s opening of the right coronary artery effected by dissection,which was type A2C according to the refined classification criteriaby Sun Lizhong; In the patients with simply Stanford B type aortic dissection,1 patient combined with Marfan syndrome,2 patients combined with hypertension and1 patient' s whole abdominal aorta suffered by dissection,while according to the refined classification criteriaby Sun Lizhong,3patients were type B1S and 1 patient is type B3C ; The dissection type of the patient with aortic root aneurysm combined withStanford B aortic dissection was type B1C according to the refined classification criteriaby Sun Lizhong.Based on the above specific type and clinical characteristics,patients were given conservative treatment,aortic endovascular repair and surgical therapy,the fetus were received cesarean section orabortionrespectively after or intra operation.Results Two patients of this study dead,who were both with aortic dissection type A2C and died of renal failure after Bentall + Sun' sprocedure.The other patients were discharged eventually.Two patients were received cesarean section before admitted to our hospital,1 patient was received cesarean section while receiving aortic surgery,1 patient was received cesarean section after aortic surgery and all the fetus of these 4 patients survived.One patient continued the pregnancy after aortic surgery.Four patients underwent abortion before aortic surgery,1 patient received abortion simultaneously and all the fetus of these 5 patients died.Conclusion Aortic diseases during pregnancy include Stanford type A,B aortic dissection and aortic aneurysm.Treatment strategies involve medication,aortic endovascular repair and surgery.We should judge the indications of various therapies according to clinical condition during pregnancy comprehensively,in which the worst prognosis is Stanford type A aortic dissection.The treatment to fetus should be selected based on gestational age and the severity of aortic diseases.