主動脈壁間血腫的診斷與治療_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 劉剛 ¹ , 鄭德志 ² , 陳彧 ¹ , 陳生龍 ¹ , 凌云鵬 ¹

1. ;
2. ;

Corresponding?author：

劉剛, Email: liugang434@163.com

Keywords：

主動脈壁間血腫; 主動脈夾層; 外科治療; 腔內隔絕

DOI：

10.7507/1007-4848.20140197

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

目的探索主動脈壁間血腫的診斷與治療要點。方法回顧性分析北京大學人民醫院心外科2011年1月至2013年4月共收治5例主動脈壁間血腫患者的臨床資料，其中男4例、女1例，年齡35～70歲。2例行藥物治療，1例行介入治療，2例行外科手術治療，其中1例行二次手術。分析其療效和安全性。結果全組患者住院時間11～34 d，均痊愈出院。2例行外科手術患者的住院時間分別為18 d與34 d。對全組隨訪1～20個月，隨訪結束時，患者均痊愈。結論主動脈壁間血腫是一種需要積極治療的急性主動脈病變，CT增強造影具有較高診斷價值。A型主動脈壁間血腫應積極外科手術替換病變血管，B型主動脈壁間血腫可以在嚴密隨訪下行藥物治療。如果患者同時合并主動脈潰瘍等高危病變，可以選擇腔內隔絕治療。

Citation： 劉剛, 鄭德志, 陳彧, 陳生龍, 凌云鵬. 主動脈壁間血腫的診斷與治療. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(5): 690-692. doi: 10.7507/1007-4848.20140197 Copy

1.	Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol, 2010, 55(14):e27-e129.
2.	Maraj R, Rerkpattanapipat P, Jacobs LE, et al. Meta-Analysis of 143 reported cases of aortic intramural hematoma. Am J Cardiol, 2000, 86(6):664-668.
3.	Nienaber CA, Kodolitsch Y, Petersen B, et al. Intramural hemorrhage of the thoracic aorta. Diagnostic and therapeutic implications. Circulation, 1995, 92(6):1465-1472.
4.	Evangelista A, Mukherjee D, Mehta RH, et al. Acute intramural hematoma of the aorta:a mystery in evolution. Circulation, 2005, 111(8):1063-1070.
5.	Song JK. Aortic intramural hematoma:aspects of pathogenesis 2011. Herz, 2011, 36(6):488-497.
6.	Hoey ET, Wai D, Ganeshan A, et al. Aortic intramural haematoma: pathogenesis, clinical features and imaging evaluation. Postgrad Med J, 2012, 88(1045):661-667.
7.	Chao CP, Walker TG, Kalva SP, et al. Natural history and CT appe-arances of aortic intramural hematoma. Radiographics, 2009, 29(3):791-804.
8.	Chiu KW, Lakshminarayan R, Ettles DF. Acute aortic syndrome:CT findings. Clin Radiol, 2013, 68(7):741-748.
9.	Evangelista A, Dominguez R, Sebastia C, et al. Long-term follow-up of aortic intramural hematoma:predictors of outcome. Circulation, 2003, 108(5):583-589.
10.	Harris KM, Braverman AC, Eagle KA, et al. Acute aortic intramural hematoma:an analysis from the International Registry of Acute Aortic Dissection. Circulation, 2012, 126(suppl 1):S91-S96.
11.	何庚戌, 周峰, 濮仁富, 等. Stanford B型主動脈壁間血腫的治療.中國胸心血管外科臨床雜志, 2011, 18(4):361.
12.	Song JK, Kim HS, Kang DH, et al. Different clinical features of aortic intramural hematoma versus dissection involving the ascending aorta. J Am Coll Cardiol, 2001, 37(6):1604-1610.
13.	Moizumi Y, Komatsu T, Motoyoshi N, et al. Clinical features and long-term outcome of type A and type B intramural hematoma of the aorta. J Thorac Cardiovasc Surg, 2004, 127(2):421-427.
14.	Song JM, Kim HS, Song JK, et al. Usefulness of the initial noninvasive imaging study to predict the adverse outcomes in the medical treatment of acute type A aortic intramural hematoma. Circulation, 2003, 108(suppl 1):Ⅱ324-Ⅱ328.
15.	Kruse MJ, Johnson PT, Fishman EK, et al. Aortic intramural hematoma:review of high-risk imaging features. J Cardiovasc Comput Tomogr, 2013, 7(4):267-272.

1. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol, 2010, 55(14):e27-e129.
2. Maraj R, Rerkpattanapipat P, Jacobs LE, et al. Meta-Analysis of 143 reported cases of aortic intramural hematoma. Am J Cardiol, 2000, 86(6):664-668.
3. Nienaber CA, Kodolitsch Y, Petersen B, et al. Intramural hemorrhage of the thoracic aorta. Diagnostic and therapeutic implications. Circulation, 1995, 92(6):1465-1472.
4. Evangelista A, Mukherjee D, Mehta RH, et al. Acute intramural hematoma of the aorta:a mystery in evolution. Circulation, 2005, 111(8):1063-1070.
5. Song JK. Aortic intramural hematoma:aspects of pathogenesis 2011. Herz, 2011, 36(6):488-497.
6. Hoey ET, Wai D, Ganeshan A, et al. Aortic intramural haematoma: pathogenesis, clinical features and imaging evaluation. Postgrad Med J, 2012, 88(1045):661-667.
7. Chao CP, Walker TG, Kalva SP, et al. Natural history and CT appe-arances of aortic intramural hematoma. Radiographics, 2009, 29(3):791-804.
8. Chiu KW, Lakshminarayan R, Ettles DF. Acute aortic syndrome:CT findings. Clin Radiol, 2013, 68(7):741-748.
9. Evangelista A, Dominguez R, Sebastia C, et al. Long-term follow-up of aortic intramural hematoma:predictors of outcome. Circulation, 2003, 108(5):583-589.
10. Harris KM, Braverman AC, Eagle KA, et al. Acute aortic intramural hematoma:an analysis from the International Registry of Acute Aortic Dissection. Circulation, 2012, 126(suppl 1):S91-S96.
11. 何庚戌, 周峰, 濮仁富, 等. Stanford B型主動脈壁間血腫的治療.中國胸心血管外科臨床雜志, 2011, 18(4):361.
12. Song JK, Kim HS, Kang DH, et al. Different clinical features of aortic intramural hematoma versus dissection involving the ascending aorta. J Am Coll Cardiol, 2001, 37(6):1604-1610.
13. Moizumi Y, Komatsu T, Motoyoshi N, et al. Clinical features and long-term outcome of type A and type B intramural hematoma of the aorta. J Thorac Cardiovasc Surg, 2004, 127(2):421-427.
14. Song JM, Kim HS, Song JK, et al. Usefulness of the initial noninvasive imaging study to predict the adverse outcomes in the medical treatment of acute type A aortic intramural hematoma. Circulation, 2003, 108(suppl 1):Ⅱ324-Ⅱ328.
15. Kruse MJ, Johnson PT, Fishman EK, et al. Aortic intramural hematoma:review of high-risk imaging features. J Cardiovasc Comput Tomogr, 2013, 7(4):267-272.

Previous Article
Research Progress of Vascular Tumor Embolus in Esophageal Cancer
Next Article
支氣管鏡聯合胸腔鏡手術治療大咯血32例臨床體會

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

主動脈壁間血腫的診斷與治療

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content