主动脉壁间血肿的诊断与治疗_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 刘刚 ¹ , 郑德志 ² , 陈彧 ¹ , 陈生龙 ¹ , 凌云鹏 ¹

1. ;
2. ;

Corresponding author：

刘刚, Email: liugang434@163.com

Keywords：

主动脉壁间血肿; 主动脉夹层; 外科治疗; 腔内隔绝

DOI：

10.7507/1007-4848.20140197

Video：

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目的探索主动脉壁间血肿的诊断与治疗要点。方法回顾性分析北京大学人民医院心外科2011年1月至2013年4月共收治5例主动脉壁间血肿患者的临床资料，其中男4例、女1例，年龄35～70岁。2例行药物治疗，1例行介入治疗，2例行外科手术治疗，其中1例行二次手术。分析其疗效和安全性。结果全组患者住院时间11～34 d，均痊愈出院。2例行外科手术患者的住院时间分别为18 d与34 d。对全组随访1～20个月，随访结束时，患者均痊愈。结论主动脉壁间血肿是一种需要积极治疗的急性主动脉病变，CT增强造影具有较高诊断价值。A型主动脉壁间血肿应积极外科手术替换病变血管，B型主动脉壁间血肿可以在严密随访下行药物治疗。如果患者同时合并主动脉溃疡等高危病变，可以选择腔内隔绝治疗。

Citation： 刘刚, 郑德志, 陈彧, 陈生龙, 凌云鹏. 主动脉壁间血肿的诊断与治疗. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(5): 690-692. doi: 10.7507/1007-4848.20140197 Copy

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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型主动脉壁间血肿的治疗.中国胸心血管外科临床杂志, 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型主动脉壁间血肿的治疗.中国胸心血管外科临床杂志, 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.

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主动脉壁间血肿的诊断与治疗

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