急性主动脉综合征的诊断和治疗

Diagnosis and treatment of acute aortic syndrome

目的探讨包括急性主动脉夹层形成(AD)主动脉壁间血肿(IMH)和穿透性主动脉溃疡(PAU)的诊断和治疗方法。方法 2004年9月至2009年1月,南京医科大学附属第一医院血管外科共收治126例急性主动脉综合征(AAS)病人,其中StanfordB型AD98例采用腔内支架人造血管植入术,必要时辅以颈-颈动脉旁路术或颈-颈-锁骨下动脉旁路术,IMH19例,药物治疗,PAU8例,腔内支架人造血管植入治疗,必要时辅以股-股动脉旁路术,1例因经济原因放弃腔内治疗。随访3个月至3年,随访率78%。结果 1例IMH病人在治疗过程中出现急性Stanford A型AD抢救无效死亡,1例Stanford B型AD病人腔内支架人造血管植入术后半年死于急性Stanford A型AD,1例Stanford B型AD病人腔内支架人造血管植入术后双下肢缺血性神经损伤未能完全恢复。其余病人无不良事件发生。结论腔内支架人造血管植入术是治疗Stanford B型AD和PAU的安全、有效的手段,辅以必要的动脉旁路手术可以扩大其适应证;药物治疗是控制IMH的有效方法,有良好的近、中期疗效。

Ohjective To explore the diagnosis and treatment of acute aortic syndrome including acute aortic dissection, intramural aortic hematoma and penetrating atherosclerotic aortic ulcer. Methods From Sep. 2004 to Jan. 2009, 126 cases of acute aortic syndrome were admitted. Among them, 98 cases with Standford B type aortic dissection received endovascular repair,19 cases with intramural aortic hemaloma received medication therapy, 8 cases with penetrating atherosclerotic aortic ulcer received endovascular repair, l patient refused endovascular repair for economic reseaon. Some cases nnderwent arterial by-pass before endovascular repair on demanding. The time of follow-up was 3 months to 3years.The rate of follow-up was 78%. Results One case with Standford B type aortic dissection died from acute Standford A type aortic dissection 6 months after endovascular repair. One case with intramural aortic hematoma died from acute Standford A type aortic dissection （luring medication therapy. One case with Standford B type aortic dissection did not recover from ischemia nerve injm7 of the legs totally after endovascular repair. ＇][＇he others were cured without serious complications. Conclusion Endovascular repair is a safe and effect method of Standford B type aortic dissection and penetrating atheroselerotic aortie ulcer. The indications eouht be increased by arterial by-pass. The results of medication therapy on intramural aortic hematoma were acceptable.