主动脉夹层23例临床诊治分析

目的 探讨主动脉夹层的临床特点、诊断与治疗.方法 回顾分析我院2006年1月至2008年4月收治的23例主动脉夹层患者的临床表现、影像学资料、治疗及转归情况.结果 23例主动脉夹层中Ⅰ型8例、Ⅱ型5例、Ⅲ型10例,均合并有原发性高血压.临床表现典型者20例,占86.9%(20/23);不典型者3例,占13.0%(3/23).6例Ⅰ型夹层和5例Ⅱ型夹层行外科手术治疗,恢复顺利;1例Ⅰ型夹层和10例Ⅲ型夹层行覆膜支架腔内隔绝术治疗,Ⅰ型夹层患者于术后第7天凌晨起床小便时突然死亡,10例Ⅲ型夹层患者恢复顺利,未见不良反应;另1例Ⅰ型夹层患者因并发上消化道大出血而死亡.结论 主动脉夹层临床表现典型者占绝大多数;不典型者占少数,极易发生漏诊和误诊,在中老年高血压患者中应保持警惕和注意识别,主动脉螺旋CT或磁共振(MRI)增强扫描检查是确诊的较好方法之一.Ⅰ型夹层和Ⅱ型夹层的治疗应以外科手术为主,而覆膜支架腔内隔绝术则是Ⅲ型夹层安全而有效的治疗方法.

The clinical analysis on the diagnosis and treatment of aortic dissection in twenty-three patients

Objective To investigate the clinical features, diagnosis and treatment of aortic dissection. Methods Clinical data including manifestations,imageology, treatment and turnover in 23 patients with aortic dis-section, hospitalized in our hospital from January 2006 to April 2008, were retrospectively analyzed. Results There were 8,5 and 10 cases classified in type Ⅰ ,type Ⅱ and type Ⅲ,all of them were complicated with hypertension. Typi-cal syndromes were manifested in 20 patients (86.9%) and were not in the others (13.0%). Surgical operation were performed in 6 patients of type Ⅰ and 5 patients of type Ⅱ, and endovascular repairments were performed in Ⅰ patient of type Ⅰ and 10 patients of type Ⅲ. All the patients were recovered except that two patients of type Ⅰ died. Conclusions Most patients with aortic dissection present typical manifestision. CT or MRI is one of the most valua-ble diagnosis. The patients in type Ⅰ and type Ⅱ should be treated with the surgical operation, and the patients in type Ⅲ with endovascular stent-graft repairment.