摘要
目的探讨病变段主动脉壁有钙化斑的Stanford B型主动脉壁间血肿患者的治疗方案。方法2009年3月—2012年3月收治15例主动脉壁有钙化斑的Stanford B型主动脉壁间血肿患者,均经64排CTA全主动脉扫描确诊病变段。15例患者死亡1例,7例行主动脉腔内修复术(TEVAR),7例全程保守治疗,并进行1年随访,在3、6个月及1年时复查主动脉CTA。结果 21例中1例入院后停止服用长期使用的抗血小板药物,突发心肌梗死死亡。7例TEVAR治疗和7例严格药物保守治疗患者,均无症状出院。失访1例,随访13例,于发病3、6、12个月复查主动脉CTA,壁间血肿均逐渐减少或吸收,无症状复发患者。结论病变段主动脉壁有钙化斑的Stanford B型主动脉壁间血肿患者治疗的关键是防止其恶化,在严格保守治疗的同时,对需长期口服抗凝抗血小板药物者、严格保守治疗过程中症状不缓解者、症状缓解后复发者、定期影像学检查壁间血肿或(和)主动脉穿透性溃疡进展者要及时行TEVAR治疗。
Objective To investigate the suitable therapeutic schedule for Stanford B aortic intramural hematoma associated with calcification. Methods During the period from March 2009 to March 2012, a total of 15 patients of Stanford B aortic intramural hematoma with calcified plaque were admitted to authors’ hospital. The diagnosis was proved in all patients by CT angiography of the entire aorta with a 64-row CT scanner. Of the 15 patients, death occurred in one, thoracic endovascular aortic repair （TEVAR） treatment was adopted in 7 and conservative therapy was carried out in 7. All the patients were followed up for one year. CT angiography was employed at 3, 6 and 12 months after the treatment to evaluate the therapeutic results. Results One patient died of acute myocardial infarction after admission to hospital when the long-tem use of antiplatelet drugs was stopped. Seven patients received TEVAR treatment and the remaining 7 patients were treated with strict conservative therapy, and all these patients were asymptomatic at the time of discharge. During the follow- up period, CT angiography performed at 3, 6 and 12 months after the treatment showed that the intramural hematoma lesions gradually shrank or were absorbed in 13 patients, and the patients were asymptomatic. The remaining one patient was lost in touch. Conclusion The key to treat Stanford B aortic intramural hematoma with calcification is to prevent deterioration of the lesion. While strict conservative treatment is kept on, TEVAR should be promptly carried out for patients who need to take antiplatelet drugs over a long period of time, for patients whose clinical symptoms are not improved, for patients in whom the relived symptoms recur, and for patients whose CT angiography shows that the penetrating aortic ulcer becomes worse.
出处
《介入放射学杂志》
CSCD
北大核心
2014年第7期575-578,共4页
Journal of Interventional Radiology
关键词
壁间血肿
主动脉穿透性溃疡
钙化斑
治疗
intramural hematoma
penetrating aortic ulcer
calcified plaque
treatment
