| 主动脉穿透性溃疡的临床特点与治疗方法 |
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| 引用本文： | 尤家运,余朝文,聂中林,高涌,卢冉,王强,王辰萌.主动脉穿透性溃疡的临床特点与治疗方法[J].中华全科医学,2021,19(5):778-781. |
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| 作者姓名： | 尤家运 余朝文 聂中林 高涌 卢冉 王强 王辰萌 |
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| 作者单位： | 蚌埠医学院第一附属医院血管外科，安徽 蚌埠 233004 |
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| 基金项目： | 安徽省科技攻关项目201904a07020020 |
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| 摘 要： | 目的 分析并总结主动脉穿透性溃疡(penetration aortic ulcer，PAU)患者的临床特点及治疗方法的选择。 方法 回顾性分析2016年1月—2019年11月蚌埠医学院第一附属医院血管外科收治的32例PAU患者的临床资料，其中保守治疗组12例，主动脉腔内修复(endovascular aneurysm repair，EVAR)组20例，对2组患者的临床特点及治疗效果进行分析。 结果 EVAR组患者住院时间较保守治疗组短、入院时D-二聚体水平较保守治疗组高(均P＜0.05)，EVAR组患者溃疡直径、溃疡深度及并发主动脉壁内血肿(intramural hematoma，IMH)与保守治疗组相比较，差异有统计学意义(均P＜0.05)，其他方面差异均无统计学意义(均P＞0.05)。近期随访中保守治疗组患者新发主动脉夹层的发生率高于EVAR组，差异有统计学意义(P＜0.05)，中远期随访中2组间溃疡增大、新发主动脉夹层的发生率EVAR组均略低于保守治疗组，但差异无统计学意义(P=0.089、0.089)，其他指标相比差异均无统计学意义(均P＞0.05)。 结论 EVAR治疗PAU是一种安全、有效的方法，与保守治疗相比较，可降低近期主动脉夹层发生率。对于持续性疼痛症状、合并IMH以及有主动脉破裂征象的患者建议积极行EVAR治疗。
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| 关 键 词： | 主动脉穿透性溃疡 主动脉壁内血肿 临床特点 主动脉腔内修复术 疗效 |
| 收稿时间： | 2020-09-25 |
Clinical characteristics and treatment of penetrating aortic ulcer |
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| Affiliation: | Department of Vascular Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China |
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| Abstract: | Objective To analyse and summarise the clinical characteristics of patients with penetrating aortic ulcer (PAU) and the choice of treatment. Methods Clinical data of 32 PAU patients admitted to the Vascular Surgery Department of the First Affiliated Hospital of Bengbu Medical College from January 2016 to November 2019 were retrospectively analysed, including 12 cases in the conservative treatment group and 20 cases in the endovascular aneurysm repair (EVAR) group. The clinical characteristics and therapeutic effects of the two groups were analysed. Results The hospital time of the patients in the EVAR group was short compared with the conservative treatment group (all P < 0.05). The D-dimer level, ulcer diameter, depth of the ulcer and concurrent aortic intramural hematoma (intramural hematoma, IMH) of the EVAR group were higher compared with those of the conservative treatment group, and the differences were statistically significant (all P < 0.05). No statistically significant differences were observed in the other areas (all P>0.05). Recent follow-up on new conservative treatment group patients showed that the incidence of aortic dissection was higher than that in the EVAR group, and the difference was statistically significant (P < 0.05). Long-term follow-up showed that the risk of ulcer increases for the two groups. The incidence of new aortic dissection for the EVAR group was slightly lower than that for the conservative treatment group, but there was no statistically significant difference (P=0.089, 0.089). Other indicators had no statistically significant differences (all P>0.05). Conclusion EVAR is a safe and effective method in the treatment of PAU as it can reduce the incidence of recent aortic dissection compared with the conservative treatment. EVAR is recommended for patients with persistent pain symptoms, combined IMH and signs of aortic rupture. |
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