非手术与介入手术治疗B型主动脉壁间血肿的疗效比较

Comparison of the effect of nonoperative and interventional surgery in the treatment of type B aortic intramural hematoma

目的 比较非手术治疗及介入手术治疗B型主动脉壁间血肿(AIH)患者的临床疗效。方法 收集蚌埠医科大学第一附属医院血管外科2018年6月~2022年6月收治入院的40例B型AIH患者的临床资料并通过电话进行随访,其中16例患者接受介入手术治疗(手术组),24例患者接受非手术治疗(非手术组),比较两组患者入院时的D-二聚体(D-D)水平、最大胸主动脉直径、胸主动脉壁厚度、是否合并主动脉溃疡及溃疡深度、死亡率等。结果 两组患者入院后的D-D水平、胸主动脉最大直径及胸主动脉厚度差异均无统计学意义(P> 0.05),两组患者中合并主动脉溃疡、胸主动脉壁内合并局灶性造影剂增强的比例及主动脉溃疡深度差异均存在统计学意义(P<0.05);非手术组死亡2例(8.30%),手术组无患者死亡(0.00%),但差异无统计学意义(P> 0.05)。结论 对于存在主动脉溃疡、主动脉壁厚大于10 mm且胸主动脉壁内合并局灶性造影剂增强复杂CTA表现的B型AIH患者,应进行介入手术治疗,有利于提高患者预后;同时良好地控制血压及心率,可以提高B型AIH患者生存率,降低主动脉相关不良事件的发生率。

Objective To compare the clinical outcomes of nonsurgical and interventional procedures for the treatment of patients with type B aortic intermural hematoma(AIH).Methods Clinical data of 40 patients with type B AIH admitted to the Department of Vascular Surgery of the First Affiliated Hospital of Bengbu Medical University from June 2018 to June 2022 were collected and for follow-up by telephone.And 16 patients received interventional surgery(surgical group),24 patients received nonoperative treatment(nonoperative group).The level of D-dimer(D-D),the maximum diameter of thoracic aorta,the thickness of thoracic aorta wall,the presence or non-presence of aortic ulcer,the depth of aortic ulcer and the mortality were compared between the two groups.Results There were no statistically significant difference in D-D,the maximum diameter of thoracic aorta and thoracic aorta thickness between the two groups after admission(P>0.05),and there were statistically significant differences in the proportion of patients with aortic ulcer and focal contrast enhancement in the aortic wall,the depth of aortic ulcer between the two groups(P<0.05).Two patients died in the nonoperative group(8.30%),and no patients died in the surgical group(0.00%),but there was no statistically significant difference(P>0.05).Conclusion For type B AIH with complex CTA manifestations such as aortic ulcer,aortic wall thickness greater than 10 mm and focal contrast enhancement in the aortic wall,the surgical treatment should be performed to improve the prognosis of patients.At the same time,good control of blood pressure and heart rate can improve the survival rate of type B AIH patients and reduce the incidence of aortic related adverse events.