105例不同分型主动脉壁内血肿患者的临床分析及治疗

Clinical analysis and treatment of 105 patients with different types of aortic intramural hematoma

目的探讨105例不同分型主动脉壁内血肿(IMH)患者的临床分析及治疗。方法选取2012年01月至2017年05月十堰市太和医院(湖北医药学院附属太和医院)收治105例IMH的患者,分为Stanford A型壁内血肿22例,Stanford B型壁内血肿83例。统计并比较Stanford A和B型壁内血肿患者临床资料和治疗方式。随访期间结合其手术类型的不同,重点观察了解支架修复患者的支架形态、位置、溃疡突起封闭情况、是否有内漏、血肿吸收程度、主动脉重塑情况。结果22例Stanford A型壁内血肿患者均选择急性期外科手术治疗;83例Stanford B型壁内血肿患者中,57例患者气管插管静脉麻醉下行胸主动脉覆膜支架腔内隔绝术(TEVAR)。Stanford A型壁内血肿患者年龄和甘油三酯低于Stanford B型壁内血肿患者;升主动脉直径和D-二聚体高于Stanford B型壁内血肿患者,差异有统计学意义(P<0.05);22例Stanford A型壁内血肿患者手术成功率95.5%,死亡1例;57例Stanford B型壁内血肿患者手术成功率100%;26例Stanford B型壁内血肿患者保守治疗院内死亡1例。103例患者总体生存率为95.2%;Stanford A型壁内血肿患者随访期间无死亡及术后严重并发症;Stanford B型壁内血肿保守治疗患者中1例死亡;4例进展为StanfordB型夹层入院行TEVAR术。所有TEVAR术后支架无移位,无近远端新发夹层,无内漏,主动脉无扩张。结论IMH是一种相对危重而特殊的主动脉疾病,根据疾病分型、临床合并症和高危因素等选择不同治疗方法,早期明确诊断和早期选择个体化干预方案,以获得良好临床疗效。

Objective To investigate the clinical analysis and treatment of 105 intramural aortic hematoma(IMH)patients with different types of aortic intramural hematoma.Method From January 2012 to May 2017,105 patients with IMH in the Affiliated Taihe Hospital of Hubei University of Medicine were selected and divided into 22 cases of Stanford type A intramural hematoma and 83 cases of Stanford type B intramural hematoma.The clinical data and treatment of Stanford type A and B intramural hematoma were compared.During the follow-up period,combined with the different types of operation,the stent shape,location,ulcer process closure,whether there is endoleak,hematoma absorption degree,aortic remodeling of patients with stent repair were mainly observed.Result Twenty two patients with Stanford type A intramural hematoma were treated with surgical treatment in acute stage;among 83 patients with Stanford type B intramural hematoma,57 patients underwent thoracic endovascular aortic repair(TEVAR)under endotracheal intubation and intravenous anesthesia.The age and triglyceride of patients with Stanford type A intramural hematoma were lower than those of Stanford type B intramural hematoma;the diameter of ascending aorta and D-dimer were higher than those of Stanford B intramural hematoma(P<0.05);the operation success rate of 22 patients with Stanford type A intramural hematoma was 95.5%,and 1 case died;57 cases of Stanford type B intramural hematoma:the success rate was 100%,26 patients with Stanford B intramural hematoma were treated conservatively and 1 died in hospital.The overall survival rate of 103 patients was 95.2%;there was no death and serious postoperative complications in the follow-up period of Stanford type a intramural hematoma;1 case died in the conservative treatment of Stanford type B intramural hematoma;4 cases developed into Stanford type B dissection and were admitted to hospital for TEVAR.There was no stent displacement,proximal or distal dissection,endoleak and aortic dilatation after TEVAR.Conclusion IMH is a relatively critical and special aortic disease.According to the disease classification,clinical complications and highrisk factors,different treatment methods should be selected,early diagnosis and individualized intervention should be selected in order to obtain good clinical effect.