A型主动脉壁间血肿的单中心治疗分析

Analysis of type A intramural hematoma management strategy in single center

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。

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 .