螺旋CT血管造影诊断主动脉瘤的临床应用价值

目的探讨多层螺旋CT血管造影在诊断腹主动脉瘤中的应用价值。方法收集我院腹主动脉瘤患者44例,均行多层螺旋CT扫描检查后,采用不同重建方式进行图像后处理,观察病变部位影像学特征。结果44例患者均能够显示清晰瘤体以及周围血管与瘤体的位置关系,且可观察附壁血栓并能准确测量动脉瘤的三维数据。本组44例腹主动脉瘤患者螺旋CT血管造影资料显示,均存在附壁血栓症状,其中,合并髂动脉瘤4例,有动脉瘤破裂迹象4例。多平面重建可清晰显示动脉瘤局限部位及其与周围组织、血管解剖关系,而最大密度投影法、容积再现技术能进一步对管腔各段较精确测量。结论螺旋CT血管造影扫描检查腹主动脉瘤具有操作简便、快速、直观及诊断准确等特点．县一种腹丰动脉瘤有效的榆杏方法．     

主动脉窦瘤破裂及其合并症的超声心动图诊断

目的：探讨超声心动图在主动脉窦瘤破裂及其合并症中的诊断价值。方法：将18例主动脉窦瘤破裂患者的超声心动图检查结果与手术病理检查结果进行对比。结果：超声心动图确诊主动脉窦瘤破裂17例,与手术病理诊断符合率为94.44%;确诊有合并症12例,与手术病理诊断符合率为92.31%。结论：超声心动图在主动脉窦瘤破裂及其合并症中诊断结果与手术病理检查结果符合率高,能为治疗方案的选择提供可靠的依据,且无创,可作为首选检查方法。     

Aortic root replacement

Objective To report our operative experience with aortic root replacement in 231 patients with aortic root aneurysm and discuss the current indications, methods, and surg ical techniques.Methods Between January 1994 and August 1999, a group of 231 consecutive patients underw ent aortic root replacement at our hospital, with 13 being treated on an emergen cy basis. There were 189 men and 42 women, ranging in age from 14 to 69 years. The diameter of the aneurysm varied from 4.5 to 11 cm. Among this group, 145 had isolated aortic root aneurysms, 65 suffered from DeBakey type Ⅰ aortic dis section, and the remaining 21 were diagnosed as having DeBakey type Ⅱ aortic di ssection. Aortic valve regurgitation occurred in all cases. Aortic root replac ement was performed with composite valved graft in 229 patients, and in 2 patien ts the aortic valve was preserved.Results The hospital mortality rate was 3.03% (7 patients). Early complications includ ed re-exploration for bleeding in 6 patients, pericardial effusion in 9, as wel l as cerebral infarction, pleural effusion, and pneumothorax in 2 patients each . One hundred and seventy-five patients (78.12%) were followed up, with a mea n follow-up time of 15.7±13.1 months (range, 2 weeks to 65 months). One pat ient died from lower-limb embolism and renal dysfunction 3 months postoperative ly. Three patients died from postoperative anticoagulation accidents. The preo perative and postoperative left ventricular end-diastolic diameters were s ignificantly different (68.1±9.4 mm, range 54 to 112 mm; vs 54.8±8.2 mm , range 38 to 88 mm; P<0.001).Conclusions Once a diagnosis of acute aortic root dissecting aneurysm is made, the patient s hould undergo surgery as soon as possible if the general conditions permit. Aor tic aneurysm without dissection or with chronic dissection should be operated if the diameter of the aneurysm is greater than 5 cm.     

腹主动脉瘤误诊为肾绞痛3例并文献复习

目的探讨腹主动脉瘤误诊肾绞痛的原因,早期诊疗方法。提高临床认知重视程度。方法回顾性分析以肾绞痛表现的腹主动脉瘤3例临床资料,结合国内外文献探讨腹主动脉瘤引起肾绞痛的原因及早期确诊方法。结果本组3例患者,一例确诊2d后腹主动脉瘤破裂死亡,2例积极手术痊愈。结论早期行腹部CT、彩超检查有利于确诊,腹主动脉瘤误诊肾绞痛危害大。     

彩色多普勒超声诊断主动脉夹层动脉瘤

目的探讨彩色多普勒超声对主动脉夹层动脉瘤(AD)的诊断价值。方法24例患者采用经胸超声(TTE)检查，其中10例加做经食道超声(TEE）检查。部分患者行CT、MRI、血管造影检查。结果TIE确诊率为91．7％，TEE、血管造影确诊率均为100％。CT、MRI的确诊率为87．5％和80％。结论彩色多普勒超声检查是临床诊断主动脉夹层的脉瘤的有效手段，经食道超声检查可进一步提高诊断率。     

Congenital quadricuspid aortic valve: analysis of 11 surgical cases

Background  Congenital quadricuspid aortic valve is rarely seen during aortic valve replacement (AVR). The diagnosis and treatment of the disease were reported in 11 cases.

Methods  Eleven patients (nine men and two women, mean age 33.4 years) with quadricuspid aortic valve were retrospectively evaluated. Medical records, echocardiograms and surgical treatment were reviewed.

Results  In accordance with the Hurwitz and Roberts classification, the patients were classified as type A (n=2), type B (n=7), type F (n=1) and type G (n=1). Three patients were associated with other heart diseases, including infective endocarditis and mitral prolaps, left superior vena cava, aortic aneurysm. All had aortic regurgitation (AR) except two with aortic stenosis (AS), detected by color-flow Doppler echocardiography. The congenital quadricuspid aortic valve deformity in seven patients was diagnosed by echocardiography. All patients underwent successful aortic valve replacement.

Conclusion  Quadricuspid aortic valve is a rare cause of aortic insufficiency, while echocardiography plays an important role in diagnosing the disease. Aortic valve replacement is the major therapy for the disease.

     

MRI与3D CE-MRA在胸主动脉疾病中的应用价值

目的评价磁共振成像（MRI）与三维对比增强磁共振血管造影（3D CE-MRA）诊断胸主动脉疾病的价值。方法14例（主动脉夹层5例,主动脉瘤8例,降主动脉缩窄1例）经MRI和3D CE-MRA检查诊断的主动脉疾病资料,与手术结果对比分析。结果14例病变术前MRI结合3D CE-MRA均正确诊断。1例升主动脉瘤术中见内膜轻度破损,常规MRI与3D CE-MRA未能显示。常规MRI显示主动脉双腔及内膜片更满意,但主动脉瘤形态及范围不如3D CE-MRA显示直观。结论常规MRI与3D CE-MRA结合能准确诊断主动脉瘤、夹层、假性动脉瘤及降主动脉缩窄,有助于手术方案的拟定。     

国产覆膜支架腔内修复术治疗主动脉病变的疗效

目的探讨国产覆膜支架腔内修复术治疗主动脉夹层、主动脉创伤和动脉瘤的可行性。方法13例患者术前均行CTA、MRA或彩超特殊检查,测定和了解主动脉弓部、重要分支的直径和受累情况;应用国产覆膜支架腔内修复术,治疗胸主动脉夹层动脉瘤10例（均属Stanford B型）、胸主动脉峡部外伤后裂口伴假性动脉瘤形成1例、肾下腹主动脉瘤2例。结果手术治疗均获成功。1例主动脉夹层术后第3d发生心肌梗死,经抢救无效死亡;另1例腹主动脉瘤应用连体带膜支架植入腔内修复术者,术后出现左下肢供血不足现象,1周后又行股一股动脉人工血管旁路转流术,术后恢复良好。12例患者随访1～10个月,平均4．5月,疗效满意,生活状态良好,有的已恢复工作。结论国产覆膜支架腔内修复术治疗主动脉夹层、主动脉创伤和动脉瘤成功率高,创伤小,疗效好。     

腹主动脉瘤的影像诊断及进展

近年来随着影像学诊断技术的发展,腹主动脉瘤在临床中的诊断率不断地提高,诊断的准确性和及时性使得此类患者的病死率大大地降低。该文通过总结分析相关研究,对超声、CT、磁共振成像在诊断腹主动脉瘤中的应用进行比较分析,阐述其各自的利弊及其发展概况,旨在找到更佳的影像学方式对腹主动脉瘤进行全面系统的诊断,为临床提供形态学、血流动力学信息,以期为临床诊断、手术适应证及手术方式的选择提供更好的依据。     

16层螺旋CT血管成像在腹主动脉瘤中的诊断价值

目的探讨16层螺旋CT血管成像在腹主动脉瘤中的诊断价值。方法研究对象为该院收治的28例腹主动脉瘤患者,均行16层多排螺旋CT血管成像,分析其病变检出情况。结果经过手术或DSA证实,28例腹主动脉瘤患者包括9例腹主动脉夹层动脉瘤、2例假性腹主动脉瘤及17例真性腹主动脉瘤,3例患者腹主动脉瘤出现破裂。结论 16层螺旋CT血管成像对腹主动脉瘤的诊断具有一定优势,值得临床上推广应用。     

主动脉疾病MR成像技术探讨

为评价不同MR成像序列在主动脉疾病诊断中的价值。将45例患者（其中34例主动脉夹层,11例主动脉瘤）,经自旋回波、梯度回波、单层多相采集及动态显示扫描。结果发现,在主动脉夹层患者中,SE及GRE序列的主动脉双腔、内膜片、内膜破口的显示率分别为100％、89％、30％,100％、100％、47％。在主动脉瘤患者中,SE及GRE序列均能显示主动脉梭形或局限性扩张。提示MR对主动脉疾病有肯定的价值,其中GRE序列对显示主动脉夹层的诊断更有意义。     

腹主动脉瘤合并消化系统恶性肿瘤的外科治疗

目的 探讨腹主动脉瘤腔内隔绝术在腹主动脉瘤合并消化系统恶性肿瘤患者治疗中的可行性。方法 回顾性分析2014年1月至2019年12月在北京协和医院接受治疗的28例腹主动脉瘤合并消化系统恶性肿瘤患者的临床资料及随访结果。结果 28例患者中,合并结直肠癌21例,胃癌6例,肝癌1例。所有患者均采取分期手术治疗,其中21例选择先行腹主动脉瘤腔内隔绝术,2期行肿瘤手术。所有患者术后恢复良好,无围手术期死亡,无动脉瘤破裂、肠缺血、肠瘘等并发症。出院后随访过程中1例患者出现支架内血栓形成,1例存在Ⅱ型内漏,无腹主动脉瘤相关性死亡。结论 腹主动脉瘤腔内隔绝术由于微创、不改变腹腔内解剖结构等特点,缩短了分期手术时间间隔,降低了消化系统肿瘤手术难度,是治疗方案中值得推荐的方法。     

Ultrasound screening for clinically occult abdominal aortic aneurysm.

In a review of the records of 74 patients who had undergone repair of an abdominal aortic aneurysm at a community hospital between 1977 and 1983 we found that the aneurysm had been undiagnosed before rupture in 35%; these patients had an operative death rate of 50%, whereas elective repair carried a death rate of 4%. The characteristic patient was an obese man over the age of 55 years with hypertension, coronary artery disease, cerebrovascular disease or peripheral vascular disease. Ultrasound examination was performed in 45 patients with these characteristics, and six aneurysms were diagnosed. Either surgery or computed tomography confirmed the diagnosis. The rate of false-negative results was estimated by review of the charts of 100 men over the age of 55 years who had undergone abdominal ultrasonography for other indications: no undetected aneurysms were discovered over 3 years of follow-up. Routine screening in this high-risk group would improve the rate of diagnosis of this potentially fatal condition before rupture and offer the patient the lower mortality rate associated with elective surgery.     

升主动脉内巨大血栓1例报告及文献复习

目的：分析升主动脉腔内巨大血栓的临床诊断及治疗的思路,探讨其治疗手段。方法：回顾性分析在临床上极为少见的1例升主动脉内血栓患者的临床资料,将诊治过程进行总结,并进行相关文献复习。结果：患者为男性,因常规体检发现升主动脉内占位性病变入院。主动脉CT血管成像（CTA）提示升主动脉内病变大小为22 mm×22 mm×45 mm。为避免体循环系统栓塞的发生进行病变切除和人工血管置换。术后病理证实病变性质为血栓。结论：主动脉CTA是升主动脉腔内血栓的有效检查手段。血栓清除和人工血管植入可以降低缺血性卒中复发的风险。     

主动脉窦瘤破裂的外科治疗（附5例报告）

报告5例主动脉窦瘤破裂，其中，4例有突然发病史，2例有心衰史和晕厥史。5例均破入右室，1例曾被误诊为动脉导管未闭。4例正中剖胸直视手术，其中1例在常温，3例在中度低温体外循环下施术；3例在主动脉窦瘤破入右心室处切口修复，另1例作了右心室和开主动脉两处切口修复。结果3例痊愈，1例术后死亡。还有1例转院手术治愈。     

82例主动脉窦瘤破裂的外科治疗研究

目的:总结主动脉窦瘤的临床特点和外科手术治疗方法?方法:82例主动脉窦瘤破裂患者均于体外循环下行主动脉窦瘤修补术?其中右冠窦破入右室48例,右冠窦破入右房16例,无冠窦破入右房18例?本组包括室间隔缺损39例,主动脉瓣关闭不全23例?除修补窦瘤外,同时行室间隔缺损修补术39例,主动脉瓣置换术5例,主动脉瓣成形术16例,右心室流出道疏通术5例,二尖瓣置换术1例,三尖瓣成形术8例,肺动脉瓣穿孔修补1例,主动脉瓣下狭窄切除1例?结果:本组患者全部治愈出院?术后1例因残余分流行二次手术矫治,术后主动脉瓣中度反流再次成型术1例,轻度主动脉瓣关闭不全4例,微量残余分流2例?随访患者无死亡,手术治疗效果良好,心功能改善明显?结论:主动脉窦瘤破裂明确诊断即为手术指征?应尽早手术,采取适当?有效的手术方法,疗效满意?     

Rupture of thoracic aortic aneurysm into the lung with formation of pseudoaneurysm: Diagnosis and treatment

Summary Three patients with rupture of thoracic aortic aneurysm into the lung with formation of pseudoaneurysm were admitted to our hospital in 1991, of whom, 2 had ascending aortic aneurysms which ruptured into the right upper pulmonary lobe, and another one had descending aortic aneurysm rupuring into the left upper lobe. All 3 cases were misdiagnosed as having pulmonary carcinoma or mediastinal tumor by the other hospital as well as by us. Correct diagnosis was made by aortography or at exploratory thoracotomy. Our preliminary experiences in the diagnosis and treatment of the disease are presented in this paper.     

主动脉窦瘤破裂合并主动脉瓣关闭不全的外科处理

目的总结86例主动脉窦瘤破裂合并主动脉瓣关闭不全的外科治疗经验。方法86例主动脉窦瘤破裂合并主动脉瓣关闭不全患者,合并室间隔缺损64例,感染性心内膜炎8例,右室流出道狭窄或右室双腔心10例。瘤破口和室缺均采用Dcron补片修补,主动脉瓣整形15例,主动脉瓣置换28例。余合并症均同期予以处理。结果围手术期死亡1例,远期死亡4例。再次手术3例,其中急诊二次手术1例。主动脉窦瘤破裂修补术后残余分流2例,室缺修补术后残余分流2例。其余病例心功能明显改善,主动脉瓣关闭不全减轻,临床效果良好。结论主动脉窦瘤破裂合并主动脉瓣关闭不全是少见的心脏疾病,手术是唯一有效的治疗方法。采用主动脉及心腔双切口利于心肌保护和确切修补主动脉窦瘤,纠正合并畸形。     

胸腹主动脉瘤治疗进展

目的：探讨胸腹主动脉瘤最佳治疗方法和当前治疗进展。方法：对位于胸腹主动脉各部位发生的动脉瘤，特别是夹层动脉瘤的严重性、手术风险、手术并发症、微创治疗等作初步探讨。结果：发生于胸腹主动脉各不同部位动脉瘤手术方法亦不同．升主动脉瘤合并主动脉瓣关闭不全用Bentall手术。涉及主动脉弓部和／或夹层累及全程主动脉用弓部替换和／或联合象鼻技术手术。胸降主动脉瘤和／或累及肾动脉夹层动脉瘤施行改良Crawford分段阻断法切除动脉瘤主动脉替换和／或肾动脉直视灌注法保护脊髓和肾脏血供取得良好效果。结论：外科手术仍然是当前治疗胸腹主动脉瘤的主要手段。腔内被膜支架治疗仅限于部分单纯肾动脉下腹主动脉瘤，而且腔内被膜支架治疗适应证严格。     

腔内隔绝术在破裂性腹主动脉瘤治疗中的应用

[目的]总结腔内隔绝术治疗破裂性腹主动脉瘤的经验.[方法]收集2005年1月-2011年3月采用腔内隔绝术治疗破裂性腹主动脉瘤的16例患者的临床资料.所有患者行数字减影血管造影(DSA)和/或螺旋CT血管成像检查确诊.在DSA指导下,经股动脉小切口将支架移植物导入腹主动脉内,从腔内将瘤体与血流隔绝.[结果] 16例腹主...