B型主动脉壁内血肿48例临床治疗分析

Clinical analysis of forty eight cases with type B aortic intramural hematoma

目的探讨B型主动脉壁内血肿的临床转归及治疗经验。方法我院2009年1月至2014年2月收治B型主动脉壁内血肿患者48例，回顾分析其治疗方法及近中期随访结果。结果主动脉腔内修复37例（其中31例在入院后当日行腔内修复术，6例保守治疗后病情进展在人院后7—10d转为腔内修复），术后均恢复满意，顺利出院。余11例药物治疗患者，1例进展成典型主动脉夹层死亡，10例治疗后出院。共随访39例，随访1个月～3年，所有人员均存活。保守治疗患者随访6例，4例血肿部分吸收，2例血肿无明显变化。腔内修复患者随访33例，复查CTA示支架位置形态良好，血肿部分或完全吸收。结论B型壁内血肿预后差异极大，对于存在腔内修复指征的患者，建议早期行腔内修复术以降低并发症的发生及病死率。

Objective To explore the prognosis and treatment of type B aortic intramural hematoma. Methods Forty-eight patients with type B aortic intramural hematoma were the subjects, who were admitted to our institution From Jan. 2009 to feb. 2014. We retrospectively reviewed the short and midterm follow-up results and managements. Results Thirty-seven patients recovered uneventfully after thoracic endovascular aortic repair （TEVAR）. Of them, 31 patients were repaired at the day of administration and another 6 patients were delayed to 7 - 10 days due to disease progression. For remaining 11 patients, one died of progression to overt dissection, and 10 patients discharged with medical therapy. A total of 39 cases were followed up, and all the patients were survived. During follow - up, 6 patients were in medical treatment and 4 patients with partial absorption of the hematoma, 2 patients without any change. In TEYAR patients,CT angiography showed satisfactory position and shape of the stent grafts and partial or absolute absorption of the hematoma in 33 patients. Conclusion There is a diverse variation in the prognosis of patients with type B aortic intramural hematoma. Therefore, we recommend early endovascular repair in cases with indications for stenting, which result in favorable clinical outcomes.