60岁以上非外伤性主动脉壁内血肿患者临床特点及治疗

The characteristic and treatment of intramural hematoma in elderly patients without trauma

目的总结60岁以上非外伤性患者主动脉壁内血肿(IMH)的特点及治疗方式,以期为诊治提供参考。方法回顾性分析2013年3月至2017年5月收治36例60岁以上非外伤性IMH患者,总结其临床资料,明确患者发病及影像学特点,评估治疗方案。结果17例无症状患者均给予保守治疗。19例急症患者中,7例完成急诊手术;9例患者内科治疗期间转手术治疗;3例患者仅接受药物保守治疗,其中1例血肿消失,2例进展。全组无死亡。16例行主动脉内覆膜支架置入术患者随访5~48个月,平均(23.9±10.30)个月,预后良好,目前无需再次手术干预。随访期间,手术患者主动脉增强CT提示血肿消失或明显减少,无症状患者病情稳定,所有获得影像学随访资料患者的主动脉均未见明显扩张。结论老年IMH多见于男性,其中又以StanfordB型多见,非症状性患者的IMH伴多发溃疡,但血肿范围较局限,病情进展不明显,可考虑行内科保守治疗;症状性患者血肿通常累及范围广,多由单个微小溃疡所致,病情多进展,内科治疗基础上,可考虑进一步行血管腔内治疗修复主动脉。

Objective To analyze the characteristics and treatment of aortic intramural hematoma(IMH) in non-traumatic elderly patients, and to provide clinical reference for the diagnosis and treatment of this disease. Methods A retrospective analysis of clinical data of 36 elderly patients without trauma during the period from March 2013 to May 2017 in our hospital , to clarify the characteristics of pathogenesis and imaging feature, and to evaluate treatment options. Results 36 patients were followed up and the outcomes of them were satisfactory. Of which 17 asymptomatic patients were given conservative treatment. 19 cases of emergency patients, 7 patients received the emergency operation, 9 patients were given interventional treatment after initial conservative medical treatment, 3 patients received drug treatment, of which 1 patient was conservatively successful, and 2 patients progressed. During follow-up, the imaging data of most of the patients were obtained. The aortic enhanced CT indicated that the hematoma disappeared or decreased markedly, and the asymptomatic patients were in stable condition, and the dilatation of aorta was not obvious in patients who have access to imaging examination. Conclusion Elderly patients with IMH are more common in men, especially Stanford B type. IMH in asymptomatic elderly patients with multiple penetrating aortic ulcer(PAU), but the range of hematoma is limited, no significant progress. And this type of patients can be considered only for conservative treatment. On the contrary, IMH of symptomatic elderly patients usually involve a wide range of aorta, and most of them were caused by single small ulcer. Although the patients have been treated with conservative medicine, the disease is still progress and endovascular treatment repair of aorta can be considered.