主动脉壁内血肿的外科治疗

目的总结主动脉壁内血肿（IMH）的术前诊断及外科治疗经验。方法回顾性分析2007年1月至2008年12月收治的IMH患者4例,年龄41-65岁,合并高血压病3例,其中1例同时合并扩张型心肌病,二尖瓣关闭不全,心房纤颤,心功能三级。4例患者均合并胸腔积液。4例患者术前均行超声心动图及64排螺旋CT扫描检查,其中3例经右侧股穿刺置入导管,造影确诊后,植入覆膜支架。结果本组手术无死亡,除合并扩张型心肌病、二尖瓣关闭不全的患者转内科保守治疗好转后出院,其余患者术后恢复顺利,痊愈出院。结论IMH经术前超声心动图检查多初步诊断为主动脉夹层,64排螺旋CT检查,可以明确诊断,对治疗方案的制定有重要指导意义。IMH支架植入治疗效果良好。

The surgical treatment of aortic intramural hematoma

Objective To summarize the aortic intramural hematoma（IMH） of the preoperative diagnosis and surgical treatment.Methods A retrospective analysis from January 2007 to December 2008 patients treated four cases of IMH,aged 41-65 years old,three cases of patients with hypertension,in which the merger at the same time one cases of dilated cardiomyopathy,mitral insufficiency,atrial fibrillation defibrillators,heart function three.Four cases were combined in patients with pleural effusion.4 patients underwent preoperative echocardiography and 64-slice spiral CT scan,in which the right shares by the three cases of catheter inserted,angiography confirmed after stent implantation.Results In this group died without surgery.In addition to the merger with dilated cardiomyopathy,mitral regurgitation in patients with conservative treatment to medical improvement and discharged and the remaining patients recovered uneventfully,was discharged fully recovered.Conclusion IMH by preoperative echocardiography for more than a preliminary diagnosis of aortic dissection,64-slice spiral CT examination,the diagnosis is clear,the development of treatment programs have important guiding significance.Stent treatment of IMH well.