内科与外科治疗急性A型主动脉壁间血肿的回顾性队列研究

Surgical versus conservative treatment for acute type A aortic intramural hematoma:A retrospective cohort study

目的探讨急性A型主动脉壁间血肿(intramural hematoma,IMH)外科手术治疗和内科保守治疗的疗效差异。方法回顾性分析2014年9月—2018年12月广东省人民医院连续接诊的急性A型主动脉IMH患者的临床资料。对于符合我中心外科手术指征的患者,施行外科手术治疗(外科手术组),其他患者则接受了严格的内科保守治疗(内科治疗组)。结果纳入患者127例,其中男112例、女15例,年龄(53.6±13.0)岁。85例(66.9%)患者接受了急诊手术治疗,余42例(33.1%)患者接受了严格的内科保守治疗。两组患者早期死亡率和并发症发生率差异无统计学意义(P>0.05)。外科手术组5年生存率为90.4%,内科治疗组为74.3%(P=0.010)。在内科治疗组,主动脉最大直径(升主动脉和主动脉弓)≥45 mm或最大IMH厚度(升主动脉和主动脉弓)≥8 mm的患者,其与IMH相关死亡率显著高于其他患者(P<0.001)。结论急性A型主动脉IMH患者外科手术治疗效果令人满意。在手术技术和术后管理成熟的中心,与内科保守治疗相比,外科手术治疗能够为患者提供更好的预后。

Objective To compare the outcomes following emergency surgery or conservative treatment for patients with acute type A aortic intramural hematoma(IMH).Methods Clinical data of consecutive patients diagnosed with acute type A aortic IMH in our hospital from September 2014 to December 2018 were retrospectively analyzed.The patients who met our surgical indications received surgery(an operation group)and other patients received strict conservative treatment(a conservative treatment group).Results Finally 127 patients were enrolled,including 112 males and 15 females with an average age of 53.6±13.0 years.Of 127 patients,85(66.9%)patients accepted emergency surgery and 42(33.1%)patients accepted strict conservative treatment.There was no difference between the two groups in early mortality or complications(P>0.05).The 5-year survival rate was 90.4%in the operation group and 74.3%in the conservative treatment group(P=0.010).A maximum aortic diameter in the ascending aorta and aortic arch≥45 mm and maximum thickness of IMH in the same section≥8 mm were risk factors for IMH-related death in patients undergoing conservative treatment(P<0.001).Conclusion The mortality associated with emergency surgery for patients with acute type A aortic IMH is satisfactory.In clinical centers with well-established surgical techniques and postoperative management,emergency surgical treatment may provide a better outcome than conservative treatment for patients with acute type A aortic IMH.