孤立性自发性中主动脉夹层患者的诊断与治疗  

Surgical treatment of spontaneous isolated middle aortic dissection

作　　者：刘暴[1] 宋小军[1] 郑曰宏[1] 李拥军[1] 吴巍巍[1] 陈宇[1] 叶炜[1] 曾嵘[1] 邵江[1] 陈跃鑫[1] 倪冷[1] 刘昌伟[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院西院血管外科,100032

出　　处：《中华医学杂志》2011年第42期2967-2970,共4页National Medical Journal of China

摘　　要：目的探讨少见的中主动脉自发性孤立性夹层的诊断及治疗方式选择。方法回顾性分析2007年1月至2011年6月北京协和医院血管外科收治的7例中主动脉自发性孤立性夹层（SIMAD）患者。结果7例患者中，男3例，女4例，平均年龄53岁，急性起病5例。根据夹层第一破口的部位和邻近内脏动脉的情况，6例患者采用腔内隔绝治疗，另1例行开腹主动脉一双股动脉人工血管置换术。手术均取得成功。术后6例患者均恢复良好，肝肾功能正常；1例腔内治疗患者术后第2天并发急性冠脉综合征，转人心内科行急诊冠脉支架植人术，之后恢复正常。术后复查CTA显示，腔内治疗后主动脉假腔内已基本血栓化，未发现内漏和支架移位。结论孤立性自发性中主动脉夹层因发生部位特殊且存在一定程度破裂和成瘤风险，应受到血管外科医生重视。在治疗方式上除非因解剖条件的原因，腔内治疗应当作为首选，但是腔内治疗远期效果值得我们进一步监测和评价。Objective To explore the diagnosis and treatment of spontaneous isolated middle aortic dissection（SIMAD）. Methods The clinical data of 7 SIMAD patients admitted into our hospital between January 2007 and June 2011 were retrospectively analyzed. Results There were 3 males and 4 females with an average age of 53 years old. Five patients had an acute onset. According to the original tear location and flow of celiac artery, 6 patients received endovascular repair and another patient underwent abdominal aorta- bilateral-femoral artery bypass with artificial graft. All cases were successfully treated. Six patients recovered well from the procedures. One patient suffered acute coronary artery syndrome at Day 2 after endovascular treatment. After transferal into cardiology unit, emergency pereutaneous transluminal coronary angioplasty was performed with a satisfactory outcome. The postoperative examinations of CTA （ computed tomography angiography） of all patients demonstrated that the false lumen of dissection was basically thrombolized without endoleak or stent migration. Conclusion Vascular surgeons should pay more attention to SIMAD with the potentials of rupture and aneurysm. Endovascular graft exclusion may be a first-line therapy as long as the anatomical conditions allow. However, longer follow-up and further evaluations should be performed to determine the long-term benefits.

关 键 词：中主动脉夹层 诊断 治疗 腔内修复术 

分 类 号：R654.3[医药卫生—外科学]