急性Stanford B型主动脉壁间血肿的治疗

目的 探讨急性Stanford B型主动脉壁间血肿的治疗方法和预后.方法 总结2001年1月至2008年3月收治的Stanford B型主动脉壁间血肿29例的临床资料.依据以下标准将患者分为三组:(1)有主动脉硬化性穿透性溃疡;(2)血压不易控制;(3)持续胸背部不适.符合上述任何一项的患者入选为腔内治疗组(13例),其余患者归入药物治疗组(16例).腔内治疗组采用降主动脉覆膜支架置入术;药物治疗组只接受降压、止痛等内科保守治疗.结果 本组29例患者均获随访,随访时间6～89个月,平均(19±16)个月,药物治疗组16例患者3例病情进展为夹层予支架治疗,2例突发主动脉破裂而死亡,疾病恶化率为31.25%,死亡率为12.5%;腔内支架治疗组13例患者随访期间未见夹层复发、支架移位及其他并发症.总共置入覆膜支架16个.结论 急性Stanford B型主动脉壁间血肿疾病恶化率高,腔内覆膜支架置入术是积极有效的治疗方法.

Treatment of acute type B intramural hematoma of the aorta

Objective To explore the treatment of acute type B intramural hematoma of the descending aorta.Methods This prospective study included 29 patients of acute type B intramural hematoma of the descending aorta.Thirteen patients with penetrating atherosclerotic ulcer of the aorta,intractable hypertension,or persistent pain were enrolled into endovascular intervention group receiving stentgraft implantation,while the other 16 cases were assigned to medical group receiving hypotensive medical therapy.CT scan was performed at 6th and 12th month and then yearly.Results All cases were followedup from 6 to 89 months,averaging 19.28 months.Among the 16 patients with medical therapy,3 progressed to type B aortic dissection and received stent-graft therapy,and the other 2 suffered from aortic rupture and died.The 13 patients in endovascular group with stent-graft implantation recovered smoothly with no complication nor mortality.A total of 16 endografts were used.Conclusions Acute type B intramural hematoma of the descending aorta is a potentially lethal disease,and endovascular stent-graft implantation is an effective option for the treatment.