TEVAR术后再发胸主动脉夹层破裂并食管瘘诊治分析  

Analysis of Esophagostoma with Recurring Thoracic Aortic Dissection after TEVAR

作　　者：李伦超 刘红升[1] 赵晓东[1] LI Lun-chao;LIU Hong-sheng;ZHAO Xiao-dong(Emergency Department,the First Affiliated Hospital of PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第一附属医院急救部,北京100048

出　　处：《临床误诊误治》2018年第4期1-4,共4页Clinical Misdiagnosis & Mistherapy

基　　金：国家杰出青年基金项目(No.30125020)

摘　　要：目的总结胸主动脉腔内修复术(thoracic endovascular aortic repair,TEVAR)后再发胸主动脉夹层(aortic dissection,AD)破裂并食管瘘的临床特点及诊疗思维,提高临床医生对此类患者的急救处置能力。方法回顾性分析解放军总医院第一附属医院急救部接诊的1例以急性消化道出血就诊的TEVAR术后1年再发胸主动脉夹层破裂并食管瘘患者的临床资料。结果患者因大量呕血伴排黑便3 h急诊入院。有高血压病史,平素血压控制不良;1年前因Stanford B型AD在外院行TEVAR。入院后诊断为上消化道出血予对症治疗,同时积极完善实验室检查,消化内镜及胸部增强CT扫描提示胸主动脉夹层伴食管瘘。综合临床确诊为TEVAR术后再发胸主动脉夹层(Stanford B型)破裂并食管瘘,予积极对症处理,病情稳定后转院再次行TEVAR,电话随访1个月后因失血性休克死亡。结论随着AD发病率的增加,TEVAR的广泛应用,TEVAR术后再发AD患者逐步增多。急诊医师要强化认识,在急性消化道出血的病因诊断中,要警惕AD并食管瘘的可能。Objective To summarize the clinical features and diagnostic and therapeutic considerations of the esophagostoma with recurring thoracic aortic dissection(AD)after thoracic endovascular aortic repair(TEVAR),to improve the rescue ability of clinicians for these patients.Methods We carried out a retrospective analysis of clinical data of a patient suffering from esophagostoma with recurring thoracic AD and the related literature was reviewed.Results The patient presented to our hospital with haematemesis intermittently for 3 hours with melena once.The patient had a history of hypertension without appropriate control and AD(Stanford type B)for which he received TEVAR 1 year ago.Upper gastrointestinal hemorrhage was managed after admission and relevant examinations were performed.After gastroscopy,esophagostoma was diagnosed.A contrast-enhanced CT showed thoracic AD(Stanford type B)recurred with esophagostoma,which confirmed a final diagnosis of esophagostoma with recurring thoracic AD after TEVAR.After appropriate treatment,the patient was referred to another hospital to receive TEVAR again.Consequently,the patient died of hemorrhagic shock one month after phone call follow-up.Conclusion TEVAR is widely performed due to an increase in morbidity of AD,which also leads to an increased number of patients with recurring AD.Therefore,doctors in ED should pay more attention to AD accompanied with esophagostoma in etiological diagnosis of acute gastrointestinal hemorrhage.

关 键 词：主动脉夹层 食管瘘 消化道出血 误诊 

分 类 号：R543.1[医药卫生—心血管疾病]