28例主动脉壁内血肿治疗临床分析

Clinical analysis of 28 cases of aortic intramural hematoma treatment

目的 总结主动脉壁内血肿的临床治疗经验,为临床治疗提供参考.方法 回顾性分析我院2009年1月至2014年6月收治的28例主动脉壁内血肿治疗的资料.结果 28例中A型主动脉壁内血肿5例,2例保守治疗,其中1例死亡,另1例2周后复查CTA血肿较前加重行手术治疗;3例明确诊断后行孙氏手术治疗,效果良好.其余23例为B型主动脉壁内血肿患者,其中5例保守治疗,18例行覆膜支架腔内植入术.结论 A型主动脉壁内血肿行孙氏手术治疗效果佳.单纯B型主动脉壁内血肿可行保守治疗,保守治疗期间发现血肿较前增大、血压控制不平稳、持续胸痛不缓解的患者应及时选择行覆膜支架腔内植入术治疗;B型主动脉壁内血肿伴有主动脉穿透性溃疡患者行覆膜支架腔内植入术是最佳选择.

Objective To summarize the experience of clinical treatment of aortic intramural hematoma, provide reference for clinical treatment. Methods The data of 28 cases with aortic intramural hematoma admitted in our hospital during January 2009 to June 2014 were retrospective analyzed. Results There were 5 cases with type A aortic intramural hematoma, in which 2 cases were accepted conservative treatment, among them 1 case death, another 1 was found aggravating after 2 weeks review of CTA; another 3 cases were underwent earlier Sun- style surgical treatment, and the effect was good. 23 cases of patients with type B aortic intramural hematoma, 5 cases were accepted conservative treatment, 18 accepted routine coated stent lumen implantation. Conclusion TThe results are good in Type A aortic intramural hematoma undergoing surgical treatment of Sun-style. Simply type B aortic intramural hematoma is feasible with conservative treatment. During conservative treatment period, if the hematoma is aggravating than the previous, blood pressure is not smooth and the continuous chest pain is not relieve, the coated stent should be implanted in time. For patients with Type B aortic intramural hematoma associated with aortic penetrating ulcer, coated stent lumen implantation may be the best choice.