主动脉壁间血肿患者临床疗效的初步研究

发布时间：2018-11-03 15:48

【摘要】：目的:对经保守治疗和腔内治疗的主动脉壁间血肿患者资料进行总结分析,探讨不同治疗方式之间疗效的差异,为治疗主动脉壁间血肿提供参考。材料与方法:总结分析南昌大学第二附属医院2012年1月~2016年12月期间收治的主动脉壁间血肿(intramural hematoma,IMH)患者共56例。其中Stanford A型患者16例,Stanford B型患者40例;依据采取治疗方法不同分为腔内治疗组(TEVAR术)和保守治疗组。对于腔内治疗组,根据手术时机不同,可分为急性期手术组(发病时间"f72h)和非急性期手术组(发病时间72h)。收集患者临床资料及随访资料,并分别应用方差分析、χ2检验进行统计学整理与分析。结果:IMH患者共56例,Stanford A型IMH患者13例(90%)合并有胸腔或心包积液,Stanford B型IMH患者14例(35%)合并胸腔或心包积液。Stanford A型IMH患者16例(28.6%),腔内治疗5例(31.2%),保守治疗11例(68.8%),平均随访(24.9±13.9)个月。腔内治疗组5例,患者入院CTA均示最大主动脉直径≥50mm或血肿厚度≥11mm:急性期手术组患者3例,术后无内漏,随访期内血肿减少或吸收;非急性期手术组患者2例,术前复查CTA示均进展为主动脉夹层,术后1例出现I型内漏,随访观察12月,内漏消失,另一例无内漏且血肿吸收。保守治疗组11例,入院CTA最大主动脉直径≥50mm或血肿厚度≥11mm患者7例,其中住院期间破裂死亡1例,随访期间破裂死亡1例,进展为主动脉夹层4例,复查CTA无变化者1例;入院CTA最大主动脉直径50mm且血肿厚度11mm患者4例,随访均示血肿减少或吸收。Stanford B型IMH患者40例(71.4%),腔内治疗20例(50.0%),保守治疗20例(50.0%),平均随访(27.8±14.6)个月。急性期手术组患者9例,其中入院CTA最大主动脉直径≥40mm或血肿厚度≥10mm患者6例,术后2例出现I型内漏,随访观察6~12个月内漏均消失,余4例患者随访期内均示血肿减少或吸收;入院CTA最大主动脉直径40mm且血肿厚度10mm患者3例,术后无内漏,随访期内血肿减少或吸收。非急性期手术组患者11例,其中入院CTA最大主动脉直径≥40mm或血肿厚度≥10mm患者6例,且术前复查CTA均示进展为主动脉夹层,术后无内漏,随访期内血肿减少或吸收;入院CTA最大主动脉直径40mm且血肿厚度10mm患者5例,术后无内漏,随访期内血肿减少或吸收。保守治疗20例,入院CTA最大主动脉直径≥40mm或血肿厚度≥10mm患者10例,其中院内发生脑梗死亡1例,院外不明原因死亡1例,进展为主动脉夹层6例,出现左下肢动脉血栓形成1例,血肿无变化1例;入院CTA最大主动脉直径40mm且血肿厚度10mm患者10例,随访期内均示血肿减少或吸收。Stanford A型IMH患者,当最大主动脉直径≥50mm或血肿厚度≥11mm时,具有较高的并发症发生率和死亡率,积极行腔内治疗可减少并发症和死亡。Stanford B型IMH患者,当最大主动脉直径≥40mm或血肿厚度≥10mm时,具有较高的并发症发生率和死亡率,积极行腔内治疗可减少并发症和死亡。结论:1.Stanford A型IMH患者更多合并胸腔或心包积液。2.Stanford A型IMH患者最初最大主动脉直径≥50mm或血肿厚度≥11mm时,更易出现并发症或死亡,建议积极行腔内治疗。3.Stanford B型IMH患者最初最大主动脉直径≥40mm或血肿厚度≥10mm时,更易出现并发症或死亡,建议积极行腔内治疗。
[Abstract]:Objective: To summarize the data of patients with aortic wall hematoma treated by conservative treatment and intracavitary treatment, to discuss the difference of curative effect between different treatment methods and provide reference for the treatment of aortic wall hematoma. Materials and Methods: A total of 56 patients with aortic wall hematoma (IMH) treated in the Second Affiliated Hospital of Nanchang University from January 2012 to December 2016 were analyzed. Among them, 16 of Stanford type Apatients and 40 patients with Stanford Btype were divided into endovascular treatment group (TEVAR) and conservative treatment group according to the treatment methods. For the intra-cavity treatment group, it can be divided into acute stage operation group (onset time) according to different operation timing. "f72h) and non-acute group of surgery (onset time 72h). The patient's clinical data and follow-up data were collected, and the analysis of analysis was carried out by means of analysis of variance and Table 2 respectively. Results: Among 56 patients with IMH, 13 (90%) of Stanford AIMH patients were combined with pleural or pericardial effusion, and 14 (35%) of Stanford BMI patients were combined with pleural or pericardial effusion. Sixteen patients (28. 6%) were treated with Stanford AIMH, 5 cases (31.2%) were treated in the cavity, 11 cases (68. 8%) were treated with conservative treatment, and the average follow-up was (24. 9) 13. 9) months. There were 5 cases in the intracavitary treatment group, with CTA showing the maximum diameter of the aorta and the thickness of the hematoma was 1.11mm: 3 of the patients with acute stage operation group, no internal leakage after operation, reduction or absorption of hematoma during follow-up period, 2 cases of patients with non-acute operation group, and CTA showed aortic dissection before operation. One patient developed type I internal leakage, followed up observation for 12 months, the internal leakage disappeared, and another case had no internal leakage and hematoma absorption. In the conservative treatment group, 11 patients were admitted to the hospital. The maximum aortic diameter of CTA was 50mm or the thickness of hematoma was 1.11mm. Among them, 1 case died during hospitalization, 1 case died during follow-up, 4 cases were aortic dissection and 1 case without change of CTA. The maximum aortic diameter of the admission CTA was 50mm and the hematoma was 11mm in 4 cases, and the follow-up showed that the hematoma was reduced or absorbed. 40 cases (71.4%) were treated with Stanford Btype IMH, 20 cases (50%) were treated in the cavity, 20 cases (50. 0%) were treated with conservative treatment, and the average follow-up was (27. 8-14. 6) months. There were 9 cases of acute stage operation group, in which 6 cases were admitted with the largest diameter of CTA of CTA and 10mm in thickness of hematoma, and in 2 cases with type I leakage, the leakage disappeared within 6 to 12 months after the follow-up observation, and the hematoma was decreased or absorbed during the follow-up period of 4 patients. The maximum aortic diameter of the admission CTA was 40mm and the hematoma thickness was 10mm in 3 patients, there was no internal leakage after operation, and the hematoma was reduced or absorbed during the follow-up period. There were 11 patients with non-acute operation group, in which 6 patients were admitted to CTA with the largest diameter of aorta, and 6 patients had a hematoma thickness of less than 10mm, and CTA showed that there was no internal leakage after operation, and the hematoma was reduced or absorbed during the follow-up period. The maximum aortic diameter of the admission CTA was 40mm and the hematoma was 10mm in 5 cases, there was no internal leakage after operation, and the hematoma was reduced or absorbed during the follow-up period. Among them, 20 cases were treated with conservative treatment, the largest diameter of CTA was 40mm or the thickness of hematoma was 10mm in 10 cases. Among them, there were 1 case of cerebral infarction in the hospital, 1 case of unexplained death in the hospital, 6 cases of aortic dissection, 1 case of left lower limb artery thrombosis and 1 case without change of hematoma. The maximum aortic diameter of the admission CTA was 40mm and the hematoma was 10mm in 10mm, and the hematoma was reduced or absorbed during the follow-up period. In Stanford AIMH patients, when the maximum aortic diameter was greater than 50mm or the hematoma thickness was about 11mm, there was a higher incidence of complications and mortality, and intra-cavity therapy could reduce complications and deaths. In Stanford BMI patients, when the maximum aortic diameter was 0.40mm or the haematoma thickness was about 10mm, there was a higher incidence of complications and mortality, and intra-cavity therapy could reduce complications and deaths. Conclusion: 1. Stanford AIMH patients are more complicated with pleural or pericardial effusion. 2. When the initial maximum aortic diameter of Stanford AIMH is smaller than 50mm or the thickness of hematoma is smaller than 11mm, complications or death are more likely to occur. It is recommended to actively perform intra-luminal therapy. 3. When the initial maximum aortic diameter of Stanford BIMH patients is greater than 40mm or the hematoma thickness is less than 10mm, complications or deaths are more likely to occur and are recommended for active intra-luminal therapy.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R543.1

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