不同类型主动脉夹层40例临床分析

Clinical Analysis of 40 Cases of Different Types of Dissection of Aorta

目的对于不同类型主动脉夹层患者进行临床分析,探究其病因、早期诊断与治疗方式的选择。方法从该院在2012年10月—2017年5月间接收的主动脉夹层患者中随机选取40例,其中包括9例主动脉夹层Stanford A型患者,29例主动脉夹层Satnford B型患者,1例创伤性胸主动脉夹层动脉瘤患者,1例外伤性头臂干夹层动脉瘤患者。对于9例主动脉夹层Stanford A型病患采取了深低温停循环、低流量选择性脑灌注下行升主动脉+全弓置换+远端术中支架置入术,其中的2例行"Bentall手术",1例行"保留弓顶",1例行右无名动脉、左颈总动脉、左锁骨下动脉、升主动脉转流;对于29例主动脉夹层Stanford B型病患给予主动脉夹层腔内修复术。对不同类型主动脉夹层患者接受治疗后的效果进行观察与评估。结果 1例患有主动脉夹层Stanford A型的患者在手术治疗前就发生脑梗死,手术后脑出血不止,最后救治无效死亡;2例患有外伤性夹层动脉瘤的患者在经腔内修复术的治疗下,完全康复;1例患有Stanford B型慢性夹层的患者在非手术治疗假腔内血栓形成后,破口完全闭合。另外的被调查患者在手术后没有死亡的案例,而且,随机跟踪观察39例患者3~25个月,发现患者的血管畅通没有堵塞,支架所在位置和状况一切正常,没有出现二次手术的案例。结论准确及时诊断出主动脉夹层的类型,并分析其病因,科学选择最适宜的临床治疗办法,对增强该疾病的诊治效果非常有用。

Objective To study the causes,early diagnosis and selection of treatment way of patients of different types of dissection of aorta.Methods 40 cases of patients with dissection of aorta admitted in our hospital from October 2012 to May 2017 were randomly selected,including 9 cases of patients with dissection of aorta Stanford A type,29 cases of patients with dissection of aorta Satnford B type,1 case with traumatic aortic dissecting aneurysm,1 case with traumatic brachiocephalic trunk dissecting aneurysm,and the 9 cases of patients with dissection of aorta Stanford A type used the deep hypothermic circulatory arrest,aorta ascendens under the low-flow selective cerebral perfusion,total arch replacement and distal placement of intracranial stent,including 2 cases treated with Bentall surgery,1 cases treated with arch roof reservation,1 cases treated with right arteriae anonyma,left common carotid,left subclavian artery,ascending aorta bypass,and the 29 cases with dissection of aorta Stanford B type were treated with aortic dissecting aneurysm with endovascular repair,and the treatment effect was observed and evaluated.Results 1 case of patient with dissection of aorta Stanford A type was with cesarean section before surgery,finally,the patient died due to ineffective emergency,2 cases of patients with traumatic dissecting aneurysm totally recovered after the endovascular repair,the crevasse of 1 case with Stanford B chronic intercalation was totally closed,and there were no death cases after surgery,besides,39 cases of patients were randomly followed up for three to 25 months,and the blood vessels of them was patency without obstruction,and the stent site and status were normal,without the second operation cases.Conclusion The accurate and timely diagnosis of types of dissection of aorta and analyzing the causes,and scientific selection of the most proper clinical treatment method is of important significance to enhancing the diagnosis and treatment effect.