无疼痛症状Stanford B型主动脉夹层八例误诊分析并治疗总结  

Misdiagnosed Analysis and Therapeutic Summary of 8 Patients with Painless Stanford B Aortic Dissection

作　　者：徐磊[1] 孙岩[1] 袁海[1] 孔祥骞[1] 张十一[1] 王默[1] 金星[1] 

机构地区：[1]山东大学附属省立医院血管外科,济南250021

出　　处：《临床误诊误治》2012年第11期9-11,共3页Clinical Misdiagnosis & Mistherapy

基　　金：国家自然科学基金青年科学基金资助项目(81000186);山东大学研究生自主创新基金资助项目(yzc11081/21300071613081)

摘　　要：目的探讨无疼痛症状Stanford B型主动脉夹层的临床表现及腔内修复治疗方法。方法回顾性分析我科2003年1月—2012年5月收治的8例无疼痛症状Stanford B型主动脉夹层的临床资料。结果 8例均无剧烈胸背部疼痛,表现为腰酸胀感及进食后腹胀各2例,活动后胸闷、下肢发凉、间歇性跛行及无自觉症状各1例。8例首诊均误诊,分别误诊为胃肠炎、腰椎间盘突出症、下肢动脉硬化闭塞症各2例,心功能衰竭、慢性肾功能不全各1例。8例均在常规影像学检查中发现主动脉夹层可能,进一步行相关检查确诊Stanford B型主动脉夹层,均行主动脉夹层腔内修复治疗,术后恢复良好。术后随访3～12个月,假腔内均形成血栓,无内漏,主动脉重塑效果满意。结论部分Stanford B型主动脉夹层患者起病隐匿,无典型疼痛症状,应注意避免误诊、漏诊。Stanford B型主动脉夹层行腔内修复治疗安全、有效。Objective To investigate clinical features and intracavitary repair therapy of painless Stanford B aortic dissection （AD）. Methods Clinical data of 8 patients with painless Stanford BAD admitted during January 2003 and May 2012 in our hospital were retrospectively analyzed. Results There was no severe ventrum pain in 8 patients, sore and swoln waist in 2 patients, abdominal distension after meals in 2 patients, dyspnea, cold in lower extremity, intermittent claudication and no subjective symptom in 1 patient. all 8 patients were misdiagnosed at first visit as having gastroenteritis, lubar intervertebral disc protrusion and arteriosclerosis obliterans in lower extremity in 2 patients respectively, heart failure in 1 patient and chronic kidney insufficiency in 1 patient. The possibility of AD was found by normal iconography examination and finally diagnosed by further coherence check. Thoracic endovascular aortic repair （TEVAR） was performed, and the patients recovered well after operation upon discharged. All of the false lumens were filled with thrombosis and the aortic remodelings were considered satisfactory after 3 - 12 month postoperative follow-up. Conclusion Painless Stanford B aortic dissection may be overlooked or misdiagnosed due to insidious onset and insufficient specific clinical manifestation. TE- VAR is a safe and effective therapy for Stanford BAD.

关 键 词：动脉瘤 夹层 主动脉 误诊 胃炎 

分 类 号：R543.16[医药卫生—心血管疾病]