伴发于急性Stanford-A型主动脉夹层的肺动脉鞘血肿的CT表现及预后  

Hemorrhagic Pulmonary Sheath Due to Ruptured Acute Stanford A Aortic Dissection:Incidence,CT Appearance and Consequences

作　　者：谢秋霞 王霁朏[1] 覃浩玲[1] 周旭辉[2] XIE Qiu-xia;WANG Ji-fei;QIN Hao-ling;ZHOU Xu-hui(Department of Diagnostic Radiology,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China;Department of Diagnostic Radiology,The Eighth Affiliated Hospital of Sun Yat-sen University,Shenzhen 518033,China)

机构地区：[1]中山大学附属第一医院放射科,广东广州510080 [2]中山大学附属第八医院影像科,广东深圳518003

出　　处：《中山大学学报（医学版）》2018年第2期287-291,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技计划项目(2013B021800136)

摘　　要：【目的】探讨肺动脉鞘血肿(HPS)在Stanford-A型主动脉夹层(AD)中的检出率及其CT表现,评估患者短期预后不良的危险因素。【方法】回顾性分析连续188例经CT诊断为急性Stanford A型AD的患者,分析CT图像并记录临床资料。【结果】18例患者合并HPS,检出率为9.6%。累及右侧肺动脉9例,累及左侧肺动脉2例,双侧受累7例;9例血肿(50%)进入肺内支气管血管束周围鞘(Ⅱ型),其中7例伴周围片状实变/磨玻璃影。首诊CT后30 d内11例患者(61.1%)死亡,其中7例(63.6%)为Ⅱ型HPS,未发现病变延伸与死亡率有关联(P=0.335);腹部分支血管受累在死亡组中7例(63.6%),存活组中0例,两组比较有统计学差异(P=0.01)。【结论】急性Stan-ford-A型AD合并HPS不少见,腹部分支血管受累提示预后不良。【Objective】To retrospectively investigate the incidence,computed tomography(CT)manifestations and consequences of hemorrhagic pulmonary sheath(HPS)in Stanford A aortic dissection(AD)patients.【Methods】Institutional review board approval and informed consents were obtained.CT aortic angiography images of188consecutive acute Stanford A aortic dissection patients(mean age,59years;range:29-78years;136males,52females)were reviewed.CT images were interpreted by two independent radiologists.Clinical records were reviewed for outcomes of patients up to30days after the initial CT scan.【Results】18(9.6%)out of188patients had HPS.Right pulmonary artery was involved in9(50%),left pulmonary artery in2(11.1%)and both in7(38.9%)of the18patients respectively.HPS extending along bronchovascular sheaths(TypeⅡ)was identified in9(50%)of18patients,and7(77.8%)of them had alveolar opacity around the thickened bronchovascular sheath.Within30days of follow-up,61.1%(11/18)patients died and38.9%(7/18)patients survived with absorption of HPS.TypeⅡHPS was more prevalent in death group(7/11,63.6%)than survival group(2/7,28.6%),but not statistically significant(P=0.335).Patients in death group were more likely to have abdominal visceral arteries involvement(7/11,63.6%)than patients in survival group(0/7,0%)(P=0.010).【Conclusion】HPS was not a rare complication in patients with Stanford A AD.Abdominal visceral arteries involvement indicated poor short-term outcome in this study.

关 键 词：肺动脉鞘血肿 主动脉夹层 计算机断层扫描 血管造影术 

分 类 号：R654[医药卫生—外科学]