主动脉夹层的诊断及外科处理

目的 探讨主动脉夹层的诊断及治疗方法。方法总结26例主动脉夹层诊断治疗经验，其中男21例，女5例，年龄12—81岁，平均（54．3±3．6）岁。发病时均出现胸背部疼痛，心电图检查排除急性心肌梗塞，所有病人行CT增强或CT血管造影（CTA）检查。结果所有病人经CT检查确诊：stanfordA型4例，B型22例；入院后给予止痛及降压处理。非手术处理15例，入院7d内死亡7例，均死于夹层破裂（其中2例死于心包填塞），另2例入院后两周内分别死于夹层破裂及心衰。手术处理11例，3例病人行开胸降主动脉部分置换术，8例行带膜支架腔内置入术。1例死于降主动脉部分置换术中出血。10例外科治疗病人均获随访，随访期8个月至4年。1例病人支架置入术后1年发生升主动脉逆剥，无胸痛。其余9例病情稳定。结论CT检查对本病手术方案的制定至关重要，带膜支架植入术是本病有效的治疗手段。

Diagnosis and surgical treatment of aortic dissection

Objective To summarize our preliminary experience of dignosis and treatment of aortic dissection. Methods All the 26 cases with aortic dissection, including of 21 men and 5 women with the mean age of.54.3± 3.6 years, had chest pain, which were excluded myocardial infarction by electrocardiography. All of them were underwent contrast enhanced CT or CT angiography （CTA）. Results All patients were diagnosed by CT and type Stanford A in 4 cases and B in 22 cases, were managed with pain - released and depressurization. 15 cases were treated with no operation. 7 died of aortic dissection rapture （including of 2 cases with pericardial tamponading） in 7 days of admission, and 2 died of rapture and heart failiue respectively in 2 weeks of admission. 11 patients were performed surgical management including of desceding aorta replacement in 3 cases and endovaacular stent - graft placement in 8 cases. 1 patient died after desceding aorta replacement. 10 cases with surgical treatment had been followed up for 8 months to 4 years. 1 cases with endovascular stem - graft placement appeared hang - nail of ascending aorta without chest pain, and the other 9 were in good condition. Conclusion It is very vital for CT scan to lay out and perform operation, and endovascular stent - graft placement has good effectiveness in the treatment of aorta dissection.