妊娠期急性Stanford A型主动脉夹层的诊断与治疗

目的 总结妊娠期急性Stanford A型主动脉夹层（acute type A aortic dissection，AAAD） 患者的诊治经验。 方法 回顾性分析2008年5月至2010年7月首都医科大学附属北京安贞医院3例妊娠期AAAD患者（年龄分别为：30岁、32岁、35岁） 经手术治疗的临床资料。1例剖宫产后3 d行Sun’s手术 （全主动脉弓置换＋降主动脉支架置入手术），胎儿宫内死亡；1例行剖宫产、子宫切除术后立即实施Bentall＋Sun’s手术成功；1例先行剖宫产，保留子宫同期行升主动脉置换＋Sun’s手术。 结果 3例孕妇顺利恢复，病例2及病例3 的胎儿亦顺利恢复。术后6个月进行随访，CT （computerized tomographic） 检查提示主动脉夹层假腔血栓机化形成。3例产妇术后恢复佳，2例存活婴儿发育正常。 结论 妊娠期AAAD的治疗原则为：首先及时准确地诊断至关重要；其次保证母体血流动力学平稳；第三应保证止血确切；最后，多种方法联合应用对保证母体及胎儿的良好预后非常重要。

Diagnosis and Treatment of Acute Stanford Type A Aortic Dissection during Pregnancy

Objective To summarize our diagnostic and treatment experience for patients with acute Stanford type A aortic dissection （AAAD） during pregnancy. Methods Clinical data of 3 AAAD gravida （age of 30，32，35） who received surgical treatment in Beijing Anzhen Hospital of Capital Medical University from May 2008 to July 2010 were retros-pectively analyzed. One gravida received Sun’s procedure （total arch replacement combined with stented elephant trunk implantation） 3 days after cesarean section，but the fetus died in the uterus. Another gravida successfully underwent Bentall procedure and Sun’s procedure immediately after cesarean section and hysterectomy. The third gravida received cesarean section with the uterus in situ followed by ascending aorta replacement and Sun’s procedure. Results All the 3 puerperasrecovered uneventfully，and the 2 newborns of the second and third puerperas also lived well. The 3 puerperas were followedup for 6 months after discharge. CT scan showed organized thrombus in the aortic false lumen. During follow-up，the 3 puerperas recovered well，and the 2 infants had normal growth and development. Conclusions Management principles of AAAD during pregnancy firstly include timely and accurate diagnosis，which is of prime importance. Secondly，gravidas’hemodynamics should maintain stable. Thirdly，intraoperative hemorrhage should be satisfactorily controlled. Lastly，multi-modality treatment is very important to improve the prognosis of both gravidas and fetuses.