主动脉近端破口腔内隔绝术治疗A型主动脉壁内血肿伴心包积液近期效果观察  

Endovascular isolation of proximal aortic intimal rupture for the treatment of type A aortic intramural hematoma with pericardial effusion:observation of short-term efficacy

作　　者：张胜康[1] 尹晓清[1] 徐朝军[1] 王兆礼[1] 杨进[1] 程宇[1] ZHANG Shengkang;YIN Xiaoqing;XU Zhaojun;WANG Zhaoli;YANG Jin;CHENG Yu(Department of Cardiothoracic Surgery,First Affiliated Hospital of Hunan University of Traditional Chinese Medicine,Changsha,Hunan Province 410007,China)

机构地区：[1]湖南中医药大学第一附属医院心胸外科,湖南长沙410007

出　　处：《介入放射学杂志》2024年第8期839-843,共5页Journal of Interventional Radiology

基　　金：湖南省教育厅科学研究项目(20A364)。

摘　　要：目的观察腔内隔绝治疗A型主动脉壁内血肿(AIH)伴心包积液的近期效果,探讨A型AIH伴心包积液腔内隔绝治疗策略。方法选取湖南中医药大学第一附属医院2018年2月至2021年11月收治的12例A型AIH伴心包积液患者。所有患者术前升主动脉内膜均完整,主动脉弓部或胸降主动脉近端内膜有破口,均接受腔内隔绝术封闭治疗。4例发病1周内手术,8例保守治疗1周后择期手术,术后随访12个月。结果发病1周内手术患者术后1例恢复顺利,2例术后3个月内出现A型夹层,1例早期死亡;保守治疗1周后手术8例患者均恢复顺利。结论A型AIH伴少至中量心包积液患者经保守治疗减轻升主动脉血肿后,择期行腔内隔绝治疗的效果理想。Objective To explore the short-term efficacy of endovascular isolation treatment for type A aortic intramural hematoma(AIH)with pericardial effusion,and to discuss the endovascular isolation treatment strategy for type A AIH with pericardial effusion.Methods A total of 12 patients with type A AIH complicated by pericardial effusion,who were admitted to the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine of China between February 2018 and November 2021,were enrolled in this study.Before surgery,the intima of the ascending aorta was intact in all patients,but a rupture at the proximal intima of the aortic arch or the thoracic descending aorta was detected.All patients received endovascular isolation treatment.Among them,4 patients received endovascular isolation treatment within one week after the onset of disease,and 8 patients received selective operation after receiving conservative treatment for one week.The patients were followed up for one year.Results Among the patients who received endovascular isolation treatment within one week after the onset of disease,one patient recovered smoothly,two patients developed type A dissection within 3 months after surgery,and one died early after surgery.All the 8 patients,who received selective operation after receiving conservative treatment for one week,recovered smoothly.Conclusion For patients with type A AIH complicated by mild to moderate pericardial effusion,selective endovascular isolation treatment after receiving the conservative treatment to alleviate the ascending aortic hematoma can achieve ideal therapeutic effect.

关 键 词：主动脉壁内血肿 腔内隔绝术 保守治疗 心包积液 

分 类 号：R543.1[医药卫生—心血管疾病]