妊娠合并急性主动脉夹层围产期诊治的临床病例研究

Analysis of clinical cases with acute aortic dissection during the gestation

目的:分析妊娠合并急性主动脉夹层患者的围产期诊治方法并总结经验。方法:回顾分析2006年5月至11月华中科技大学同济医学院附属同济医院收治的4例妊娠合并急性主动脉夹层患者的临床资料。1例于全麻下行剖宫产+全主动脉弓置换+降主动脉支架置入术(Bentall手术)。1例于剖宫产术后3天行Bentall手术;1例于剖宫产术后2+月行腹主动脉置换术;1例行剖宫产+主动脉夹层腔内置换术。4例患者均保留子宫,3例新生儿存活。结果:术后6个月随访,3例产妇行计算机断层血管造影术(CTA)检查提示主动脉夹层假腔血栓机化形成;1例产妇出院不足1月未复查。4例产妇术后恢复佳,3例存活婴儿发育正常,1例新生儿死亡。结论:CTA及心脏彩超对及时准确地诊断妊娠合并主动脉夹层至关重要。术中及术后应保证母体血流动力学平稳。应根据孕周及主动脉夹层类型等多方面因素决定终止妊娠的时机及手术方式。

Objective：To study and summarize the experience of the treatment to acute aortic dissection with gestation.Methods：The clinical data of 4 pregnant patients with acute aortic dissection during May 2006 to Nov.2016 were retrospectively analyzed.One of cases received cesarean section and total aortic arch replacement and desending aortic stenting （Betall＇＇s operation） under general anesthesia.One of cases received Bentall operation after she operated cesarean section three days.The other woman underwent abdominal aortic replacement after cesarean section two months,and the last case was treated with cesarean section and aortic dissection endovascular replacement.4 cases of patients retained uterus,and 3 cases of the newborn survived.Results：After 6 months of follow-up,the computerized tomographic angiography（CTA） examination of the patients with aortic dissection showed the formation of false lumen thrombosis（1 case was not recovered because she left hospital less than1 month）.4 pregnant women were successfully recovered,3 cases of the survival newborn were normal,and 1 case of newborn died.Conclusion：CTA and echocardiography for aortic dissection pregnancy timely and accurate diagnosis is crucial.Intraoperative and postoperative should ensure maternal hemodynamics.According to the gestational age and aortic dissection type and other factors,we decides to terminate the timing and operative methods of pregnancy.