晚期妊娠合并主动脉夹层5例临床分析  

Clinical analysis of five cases of aortic dissection in the third trimester pregnancy

作　　者：黄艳君[1] 王晓[1] 姜健慧[1] 章珂珂 黄引平[1] 

机构地区：[1]温州医科大学附属第一医院产科,浙江温州325000

出　　处：《中国实用妇科与产科杂志》2017年第8期841-844,共4页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的探讨妊娠合并主动脉夹层的临床表现、诊断、治疗及预后,提高诊疗水平。方法回顾性分析2010年1月至2015年6月温州医科大学附属第一医院收治的5例晚期妊娠合并主动脉夹层患者的临床资料,分析其临床表现、诊治经过、分娩结局及预后。结果 5例患者中3例为Stanford A型,2例为Stanford B型。均为急性起病,临床表现主要为胸痛、胸闷、腰腹部疼痛等,5例均经CT血管造影(CTA)确诊,3例A型患者胸壁超声心动图(TTE)亦提示主动脉夹层。3例A型主动脉夹层行剖宫产术+Bentall’s手术+主动脉弓置换+降主动脉支架植入术,2例B型主动脉夹层行带膜支架腔内修复术及剖宫产术,所有产妇及围产儿均存活。结论妊娠合并主动脉夹层患者危险因素包括马凡综合征及高血压等,临床表现以突发疼痛为主,诊断的主要方法是TTE和CTA,应选择恰当的处理方式及手术方式以保证母婴安全。Objective To discuss the clinical manifestations,diagnosis,treatment and prognosis of the pregnancy with aortic dissection,and to raise the level of diagnosis and treatment.Methods The clinical data of 5 cases of aortic dissection in the third trimester pregnancy were retrospectively analyzed,who were treated in the First Affiliated Hospital of Wenzhou Medical University between January 2010 and June 2015.Analyze their clinical manifestations,diagnosis and treatment process,pregnancy outcome and the prognosis.Results Among 5 cases,3 cases were Stanford type A and 2cases were Stanford type B.The 5 cases were of acute onset;clinical manifestations were mainly chest pain,chest tightness and lumbar abdominal pain.The 5 cases were confirmed by CTA and 3 cases of type A were also diagnosed with aortic dissection by TTE.Cesarean section＋Bentall＇s＋aortic arch replacement＋descending aorta stent implantation surgery were performed in patients with type A aortic dissection.Thoracic endovascular aortic repair and cesarean section were performed in patients with type B aortic dissection.The women and neonates all survived.Conclusion The pregnancy complicated with aortic dissection has risk factors,such as Marfan syndrome and hypertension.Its manifestations are mainly sudden pain and its main diagnostic methods are TTE and CTA.The proper handling and operation method should be chosen to ensure the safety of mothers and infants.

关 键 词：主动脉夹层 晚期妊娠 手术治疗 

分 类 号：R714.252[医药卫生—妇产科学]