专题研究(Monographic Study)

孤立性腹主动脉夹层的诊断与治疗:附27例报告

Published at: 2016年第25卷第6期

张婉 1 , 史振宇 2 , 符伟国 2 , 陈斌 2 , 徐欣 2 , 郭大乔 2 , 蒋俊豪 2 , 杨珏 2
1 复旦大学附属华东医院 血管外科,上海 200040
2 复旦大学附属中山医院 血管外科,上海 200032
通讯作者 伟国 符 Email: fu.weiguo@zs-hospital.sh.cn
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2016.06.009
基金:

摘要

目的:总结孤立性腹主动脉夹层(IAAD)的诊治经验。方法:回顾性分析2010年1月—2015年8月期间诊治的IAAD患者的临床资料,主要包括患者一般资料、诊断与治疗方法以及生存情况。结果:共27例IAAD患者入组,其中男17例(63.0%,17/27),女10例(37.0%,10/27);合并高血压9例(33.3%,9/27);外伤性IAAD 1例(3.7%,1/27),自发性IAAD 26例(96.3%,26/27)。所有患者均由CT血管造影(CTA)明确诊断,均经腹主动脉腔内修复术(EVAR)治疗,技术成功率100%。EVAR术中植入分叉型人工血管内支架20例(74.1%,20/27),直型人工血管内支架7例(25.9%,7/27)。随访26例(96.3%,26/27),平均随访(11.8±5.0)个月,患者均正常生存,无异常腹部体征,腹主动脉CTA提示腹主动脉重构良好,未见内漏、新发夹层以及支架移位等并发症。结论:IAAD属临床少见病,发病时可以表现为腰腹痛等非特异性症状或无症状,EVAR治疗IAAD可行且近期疗效佳,但长期疗效仍待进一步随访结果。


Diagnosis and treatment of isolated abdominal aortic dissection: a report of 27 cases

Abstract

Objective: To review the experience in diagnosis and treatment of isolated abdominal aortic dissection (IAAD). Methods: The clinical data of IAAD patients admitted between January 2010 and August 2015 were reviewed, which mainly concentrated on the patients’ data of the general conditions, methods of diagnosis and treatment, and survival status. Results: A total of 27 IAAD patients were enrolled. Among them, 17 cases (63.0%, 17/27) were male and 10 cases (37.0%, 10/27) were female, 9 cases (33.3%, 9/27) had concomitant hypertension, one case (3.7%, 1/27) had post-traumatic IAAD and the remaining 26 cases (96.3%, 26/27) had spontaneous IAAD. In all patients, the definite diagnosis was made by computed tomographic angiography (CTA), and all patients underwent endovascular aortic repair (EVAR) with 100% technical success. During EVAR procedure, bifurcated stent grafts were used in 20 cases (74.1%, 20/27) and straight stent grafts were used in 7 cases (25.9%, 7/27). Followed up was conducted in 26 patients (96.3%, 26/27) for an average time of (11.8±5.0) months. All the follow-up patients were alive and the CTA showed good remodeling of the abdominal aorta without complications such as endoleak, newly developed dissection or stent graft migration. Conclusion: IAAD is a rare clinical entity, with non-specific symptoms such as lower back or abdominal pain, or no symptoms at onset. EVAR is feasible treatment method for IAAD with favorable short-term outcomes, but the long-term results require further follow-up studies.


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引用

引用本文: 婉 张, 振宇 史, 伟国 符, 斌 陈, 欣 徐, 大乔 郭, 俊豪 蒋, 珏 杨. 孤立性腹主动脉夹层的诊断与治疗:附27例报告 [J]. 中国普通外科杂志, 2016, 25(6): 833-837.
Cite this article as: ZHANG Wan, SHI Zhenyu, FU Weiguo, CHEN Bin, XU Xin, GUO Daqiao, JIANG Junhao, YANG Jue . Diagnosis and treatment of isolated abdominal aortic dissection: a report of 27 cases[J]. Chin J Gen Surg, 2016, 25(6): 833-837.