主動脈壁間血腫患者臨床療效的初步研究
發(fā)布時間：2018-11-03 15:48
【摘要】：目的:對經(jīng)保守治療和腔內(nèi)治療的主動脈壁間血腫患者資料進行總結(jié)分析,探討不同治療方式之間療效的差異,為治療主動脈壁間血腫提供參考。材料與方法:總結(jié)分析南昌大學(xué)第二附屬醫(yī)院2012年1月~2016年12月期間收治的主動脈壁間血腫(intramural hematoma,IMH)患者共56例。其中Stanford A型患者16例,Stanford B型患者40例;依據(jù)采取治療方法不同分為腔內(nèi)治療組(TEVAR術(shù))和保守治療組。對于腔內(nèi)治療組,根據(jù)手術(shù)時機不同,可分為急性期手術(shù)組(發(fā)病時間"f72h)和非急性期手術(shù)組(發(fā)病時間72h)。收集患者臨床資料及隨訪資料,并分別應(yīng)用方差分析、χ2檢驗進行統(tǒng)計學(xué)整理與分析。結(jié)果:IMH患者共56例,Stanford A型IMH患者13例(90%)合并有胸腔或心包積液,Stanford B型IMH患者14例(35%)合并胸腔或心包積液。Stanford A型IMH患者16例(28.6%),腔內(nèi)治療5例(31.2%),保守治療11例(68.8%),平均隨訪(24.9±13.9)個月。腔內(nèi)治療組5例,患者入院CTA均示最大主動脈直徑≥50mm或血腫厚度≥11mm:急性期手術(shù)組患者3例,術(shù)后無內(nèi)漏,隨訪期內(nèi)血腫減少或吸收;非急性期手術(shù)組患者2例,術(shù)前復(fù)查CTA示均進展為主動脈夾層,術(shù)后1例出現(xiàn)I型內(nèi)漏,隨訪觀察12月,內(nèi)漏消失,另一例無內(nèi)漏且血腫吸收。保守治療組11例,入院CTA最大主動脈直徑≥50mm或血腫厚度≥11mm患者7例,其中住院期間破裂死亡1例,隨訪期間破裂死亡1例,進展為主動脈夾層4例,復(fù)查CTA無變化者1例;入院CTA最大主動脈直徑50mm且血腫厚度11mm患者4例,隨訪均示血腫減少或吸收。Stanford B型IMH患者40例(71.4%),腔內(nèi)治療20例(50.0%),保守治療20例(50.0%),平均隨訪(27.8±14.6)個月。急性期手術(shù)組患者9例,其中入院CTA最大主動脈直徑≥40mm或血腫厚度≥10mm患者6例,術(shù)后2例出現(xiàn)I型內(nèi)漏,隨訪觀察6~12個月內(nèi)漏均消失,余4例患者隨訪期內(nèi)均示血腫減少或吸收;入院CTA最大主動脈直徑40mm且血腫厚度10mm患者3例,術(shù)后無內(nèi)漏,隨訪期內(nèi)血腫減少或吸收。非急性期手術(shù)組患者11例,其中入院CTA最大主動脈直徑≥40mm或血腫厚度≥10mm患者6例,且術(shù)前復(fù)查CTA均示進展為主動脈夾層,術(shù)后無內(nèi)漏,隨訪期內(nèi)血腫減少或吸收;入院CTA最大主動脈直徑40mm且血腫厚度10mm患者5例,術(shù)后無內(nèi)漏,隨訪期內(nèi)血腫減少或吸收。保守治療20例,入院CTA最大主動脈直徑≥40mm或血腫厚度≥10mm患者10例,其中院內(nèi)發(fā)生腦梗死亡1例,院外不明原因死亡1例,進展為主動脈夾層6例,出現(xiàn)左下肢動脈血栓形成1例,血腫無變化1例;入院CTA最大主動脈直徑40mm且血腫厚度10mm患者10例,隨訪期內(nèi)均示血腫減少或吸收。Stanford A型IMH患者,當(dāng)最大主動脈直徑≥50mm或血腫厚度≥11mm時,具有較高的并發(fā)癥發(fā)生率和死亡率,積極行腔內(nèi)治療可減少并發(fā)癥和死亡。Stanford B型IMH患者,當(dāng)最大主動脈直徑≥40mm或血腫厚度≥10mm時,具有較高的并發(fā)癥發(fā)生率和死亡率,積極行腔內(nèi)治療可減少并發(fā)癥和死亡。結(jié)論:1.Stanford A型IMH患者更多合并胸腔或心包積液。2.Stanford A型IMH患者最初最大主動脈直徑≥50mm或血腫厚度≥11mm時,更易出現(xiàn)并發(fā)癥或死亡,建議積極行腔內(nèi)治療。3.Stanford B型IMH患者最初最大主動脈直徑≥40mm或血腫厚度≥10mm時,更易出現(xiàn)并發(fā)癥或死亡,建議積極行腔內(nèi)治療。
[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.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R543.1
本文編號：2308231
[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.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R543.1
【參考文獻】
相關(guān)期刊論文 前6條
1 王烽;王旭東;;主動脈夾層的診治[J];中國臨床醫(yī)生雜志;2016年02期
2 葛永彬;;急性主動脈綜合征研究進展[J];國際心血管病雜志;2015年03期
3 羅建方;劉華東;;2014年歐洲心臟病學(xué)會主動脈疾病診治指南解讀[J];嶺南心血管病雜志;2014年06期
4 符偉國;唐驍;郭大喬;王玉琦;;主動脈夾層腔內(nèi)修復(fù)術(shù)后并發(fā)癥及其處理[J];臨床外科雜志;2012年05期
5 印隆林;余慧珍;陳加源;蔣瑾;吳筱蕓;李迎春;;雙源CT血管成像診斷主動脈夾層35例分析及術(shù)前評價[J];實用醫(yī)院臨床雜志;2011年06期
6 孫立忠;主動脈夾層診斷和治療相關(guān)問題探討[J];中華外科雜志;2005年18期
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