12例中晚期妊娠合并主动脉夹层的临床分析  

An Analysis of Twelve Cases with Aortic Dissection during the Second and the Third Trimester

作　　者：杨冬[1] 刘陶[1] 张军[1] 李燕娜[1] 房臻[1] 

机构地区：[1]首都医科大学附属北京安贞医院,北京100029

出　　处：《实用妇产科杂志》2015年第6期459-462,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨中晚期妊娠合并主动脉夹层的治疗方法对母儿结局的影响。方法:回顾性分析2008年1月至2014年10月首都医科大学附属北京安贞医院12例中晚期妊娠合并主动脉夹层患者的临床资料。结果:12例患者中2例因拒绝手术死亡;10例患者接受外科手术治疗,其中9例存活,1例死于手术并发症。5例Stanford A型患者接受了剖宫产或剖宫取胎术联合主动脉修复或置换手术治疗,其中1例为妊娠中期病例,其他4例为妊娠晚期病例。1例Stanford A型和2例Stanford B型病例在妊娠中期终止妊娠后行主动脉手术。1例Stanford A型和1例Stanford B型在妊娠中期病例接受主动脉手术后继续妊娠,术后Stanford A型病例妊娠至孕31周发生死胎,Stanford B型病例因子痫前期于孕30周终止妊娠。胎儿结局:死胎3例,剖宫取胎术3例,早产5例,足月产1例。6例新生儿均存活。结论:在妊娠晚期同时行剖宫产和主动脉修复或置换手术,胎儿可以获得良好结局。Objective： To evaluate the effect of the treatment to aortic dissection during the second and the third trimester on the maternal and fetal outcomes. M ethods： The clinical data of 12 pregnant patients with aortic dissection during January 2008 to October 2014 were retrospectively analyzed. Results： Among 12 patients,there were 2 patients died because of refusing aortic surgery and 10 patients accepting aortic repair or replacement surgery during pregnancy or postpartum in the second trimester or in the third trimester,and 9 of whom were alive and 1of whom died of postoperative complication. Five Stanford type A dissections underwent cesarean section combined with aortic surgery,one of whom was in the second trimester and the other 4 in the third trimester. One patient in second trimester terminated pregnancy before aortic surgery,and 1 Stanford type A dissection and 2Stanford type B dissections underwent aortic surgery in second trimester after terminated pregnancy,two of whom underwent cesarean section and one induced abortion. Two dissections underwent aortic surgery and continued to be pregnant,one of whom was Stanford type A dissection and occurred stillbirth in 31 weeks of gestation,and the other one of whom was Stanford type B dissection and terminated pregnancy for preeclampsia in 30 weeks of gestation. The fetal outcomes included 3 stillbirths,3 cesarean sections in the second trimester,5 preterm labors and 1 full-term labor. All 6 newborn babies were alive. Conclusions： Pregnant patients with aortic dissection undergoing combined cesarean section with aortic repair or replacement surgery in the third trimester can win favorable fetal outcomes.

关 键 词：主动脉夹层 妊娠 母儿结局 

分 类 号：R714.252[医药卫生—妇产科学]