Stanford B型主动脉壁间血肿腔内治疗和保守治疗的比较

Comparative study of endovascular treatment and conservative treatment of Stanford B aortic intramural hematoma

目的比较Stanford B型主动脉壁间血肿腔内治疗和保守治疗的临床疗效。方法选取2006年1月至2014年10月云南省血管外科中心收治的B型壁间血肿患者48例,14例患者行主动脉腔内修复术并给予降压、镇痛镇静治疗(腔内组),34例患者行单纯药物降压、镇痛镇静等保守治疗(保守组),对比两组患者卧床时间、血肿基本吸收率、死亡率、恶化率。结果腔内组与保守组的卧床时间、死亡率、恶化率分别为8.42±2.34天vs 12.92±3.75天、7.14%vs 14.70%、7.14%vs 32.35%,腔内组与保守组随访1、3个月的血肿基本吸收率分别为71.42%vs 47.05%、92.86%vs 64.70%,差异均有统计学意义(P<0.05)。结论腔内修复术治疗Stanford B型主动脉壁间血肿是安全可行的,但应根据影像学检查主动脉的形态、症状体征等重要因素来明确腔内修复的可行性。

Objective To compare the efficacy of endovascular treatment and conservative treatment for Stanford B aortic intramural hematoma(IMH).Methods Selected 48 Stanford B patients from vascular surgery center of Yunnan provincial treated between Jan.2006 and Oct.2014.Of them,14 patients underwent EVAR,with anti-hypertension therapy and basic pharmacological treatments such as analgesia and sedation(EVAR group).And 34 patients were simply treated with pharmacological anti-hypertension therapy and basic pharmacological treatments such as analgesia and sedation(conservative group).Bed rest time,hematoma absorption,mortality,deterioration of both groups were analyzed comparatively.Results In EVAR group and conservative group,bed rest time,mortality rate,deterioration rate were(8.42±2.34)days vs(12.92 ±3.75) days,7.14%(1 case) vs 14.70%(5 cases),7.14%(1 case) vs 32.35%(11cases)(P<0.05).During the follow-up,hematoma absorption rates in EVAR group and conservative group after treatment 1 and 3 months were 71.42% vs 47.05%,92.86% vs 64.70%,respectively(P <0.05).Conclusion EVAR treatment for Standford B IMH is safe and practicable,but imaging results,symptoms and signs and morphology of aorta should be considered carefully.