妊娠合并Stanford A型主动脉夹层外科治疗二例报告并文献复习

Surgical management of Stanford type A aortic dissection associated with pregnancy in two cases and literature review

目的总结妊娠合并Stanford A型主动脉夹层的外科治疗经验,并评价其安全性和疗效。方法回顾性分析2012-04～2018-09四川省医学科学院·四川省人民医院收治2例妊娠合并Stanford A型主动脉夹层患者经外科手术治疗(均同期行主动脉根部置换+Sun's手术+剖宫取胎术)的临床资料。结果 2例母体均存活;例1术后并发肺部感染,例2术后并发急性脊髓缺血导致的右下肢体活动受限和骶尾部褥疮,经过积极治疗均好转出院; 2例胎儿均死亡。术后随访2～11个月,心脏彩超提示主动脉瓣位人工瓣膜未见明显异常;主动脉计算机断层扫描血管成像(CTA)提示手术部位形态、结构、血流未见异常,支架远端的自体血管无扩张,假腔血栓机化形成;例1产妇恢复工作,例2产妇右下肢体肌力恢复至Ⅳ级。结论妊娠合并Stanford A型主动脉夹层患者应积极手术治疗,根据主动脉病理改变、孕周、胎儿宫内情况及患方意愿决定具体手术方式。

Objective To summarize the clinical experience of surgical management of Stanford type A aortic dissection associated with pregnancy, and to evaluate its safety and efficacy. Methods The clinical data of 2 patients with pregnancy complicated with Stanford type A aortic dissection who received surgical treatment from April 2012 to September 2018 in Sichuan Academy of Medical Sciences & Sichuan Provincial People′s Hospital were retrospectively analyzed. Both patients underwent aortic root replacement+Sun′s surgery+caesarean section at the same time. Results Both mothers survived. Case 1 was complicated with postoperative pulmonary infection. Case 2 was complicated with extremity movement restriction of the right lower limb caused by acute spinal cord ischemia injury and sacrococcygeal bedsore. Both mothers were improved and discharged after active treatment, but 2 cases of fetus died. The two mothers were followed up for 2 to 11 months after operation. No obvious abnormality of the prosthetic valve in aortic valve position was found by transthoracic echocardiography. Aortic computed tomography angiogram(CTA) detected normal aortic and valvular structure, without signs of distal dilation and with organized thrombus in the aortic false lumen. Case 1 recovered well and went to work. The body strength of right lower limb in case 2 was restored to grade Ⅳ. Conclusion Patients with pregnancy complicated with Stanford type A aortic dissection should be operated actively. The optimized surgical management should be decided according to the pathological changes of the aorta, gestational weeks, fetal intrauterine condition and the patients′ wish.