Stanford B型主动脉壁间血肿的治疗策略及疗效

Treatment strategies for Stanford type B aortic intramural hematoma and curative effect

目的:探讨Stanford B型主动脉壁间血肿的治疗方法和疗效。方法:回顾性分析弋矶山医院2016年3月~2022年10月56例Stanford B型主动脉壁间血肿患者的临床资料,男39例,女17例,平均年龄(51.8±17.1)岁;38例患者行腔内治疗,18例患者行保守治疗,总结Stanford B型主动脉壁间血肿的治疗经验及疗效。结果:临床无死亡病例;12例患者在保守治疗7 d内症状加重,出现胸背部疼痛加剧、胸闷和呼吸困难、双下肢瘫痪进行性加重伴大小便失禁,占比21.4%(12/56),急诊行主动脉腔内修复术;26例患者住院保守治疗7 d后,复查胸腹主动脉CTA,出现主动脉壁间血肿增加、主动脉溃疡、胸腔积液、B型主动脉夹层,行腔内修复术,占比35.7%(26/56);患者行手术治疗总占比67.8%(38/56)。56例患者住院期间无严重不良事件,术后随访患者胸腔积液基本吸收,11例患者出现壁间动脉瘤。结论:Stanford B型主动脉壁间血肿选择腔内修复和保守治疗均安全可行,应根据患者情况选择合适治疗方法。

Objective:To explore the treatment strategies of Stanford type B aortic intramural hematoma(IMH)and the curative outcomes.Methods:The clinical data were retrospectively reviewed in 56 patients with Stanford type B IMH treated in our hospital between March 2016 and October 2022.Of the 56 patients,39 were males,and 17 females,with an average age of(51.8±17.1)years.Thirty-eight patients received endovascular treatment and another 18 patients managed conservatively.The treatment strategies and their curative effects were summarized.r esults:No death occurred.During 7 days of conservative treatment,symptoms tended to worsen in 12 patients,including aggravated chest and back pain,chest tightness and dyspnea,progressive lower limb paralysis combined with incontinence,which accounted for 21.4%(12/56).After 7 days of conservative treatment in hospital in the patients undergone emergency endovascular aortic repair,26 patients were reexamined with thoracic and abdominal aorta computed tomography angiography(CTA).Increase in hematoma thickness,aortic ulcer,pleural effusion and type B aortic dissection were observed.These patients received endovascular repair,which accounted for 35.7%(26/56).In total,67.8%(38/56)patients underwent surgical treatment.None of the patients experienced serious adverse events during perioperative period.At follow-up visits,pleural effusion was almost absorbed,and aneurysm was found in 11 patients.Conclusion:Both endovascular repair and conservative treatment are safe and feasible for curing Stanford type B IMH,and appropriate treatment should be selected according to patient′s health condition.