Stanford B型主动脉壁间血肿单中心治疗经验

doi:10.6040/j.issn.1671-7554.0.2024.0322

摘要/Abstract

摘要： 目的评估Stanford B型主动脉壁间血肿(intramural hematoma, IMH)的治疗方法与疗效。方法选取南昌大学第二附属医院2017年8月至2023年5月期间收治的Stanford B型IMH患者368例,分析其临床资料及治疗效果。结果根据随访过程中血肿转归情况分为吸收组(n=134)和进展组(n=234),单因素分析结果显示,吸收组与进展组在年龄［(60.59±11.14)岁vs.(61.86±12.05)岁］、血小板计数［206.00(88.07)×10⁹/L vs. 187.00(86.00)×10⁹/L］、门冬氨酸氨基转移酶［18.60(19.37)U/L vs. 19.50(7.80)U/L］、降主动脉最大直径［35(6)mm vs. 34(5)mm］以及血肿远端累及6~11区［157(66.81%)vs. 66(49.25%)］方面差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,降主动脉最大直径是Stanford B型IMH进展的独立危险因素(OR=0.943,95%CI: 0.899~0.990,P=0.017)。出院患者平均随访时间(35.1±17.9)个月,失访率6.8%。药物治疗患者出院后5年生存率为77.4%,腔内治疗患者出院后5年生存率为87.6%。结论单中心经验表明Stanford B型IMH选择腔内治疗安全、有效,对于降主动脉扩张者,应警惕壁间血肿的进展,必要时手术干预。

关键词: 主动脉壁间血肿, 胸主动脉腔内修复术, 溃疡样突起, 穿透性溃疡, 壁内血池

Abstract: Objective To evaluate the treatment methods and outcomes for Stanford type B intramural hematoma(IMH). Methods A total of 368 patients with Stanford type B IMH admitted to the Second Affiliated Hospital of Nanchang University from August 2017 to May 2023 were selected for analysis of their clinical data and treatment outcomes. Results Based on the outcomes during follow-up, the patients were divided into the absorption group(n=134)and the progression group(n=234). Univariate analysis showed significant differences between the absorption and progression groups in terms of age ［(60.59±11.14)years vs(61.86±12.05)years］, platelet count ［206.00(88.07)×10⁹/L vs 187.00(86.00)×10⁹/L］, aspartate aminotransferase ［18.60(19.37)U/L vs 19.50(7.80)U/L］, maximum diameter of the descending aorta ［35(6)vs 34(5)mm］, and distal hematoma involvement of Zone 6-11 ［157(66.81%)vs 66(49.25%)］(P<0.05). Multivariate Logistic regression analysis indicated that the maximum diameter of the descending aorta was an independent risk factor for the progression of Stanford type B IMH(OR=0.943, 95%CI=0.899-0.990, P=0.017). The average follow-up time for discharged patients was(35.1±17.9)months, with a loss to follow-up rate of 6.8%. The 5-year survival rate post-discharge was 77.4% for the patient with medication treatment and 87.6% for the patient with endovascular treatment. Conclusion Single-center experience suggests that endovascular treatment for Stanford type B IMH is safe and effective. For patients with dilation of the descending aorta, vigilance is required for the progression of intramural hematoma, and surgical intervention may be considered when necessary.

Key words: Aortic intramural haematoma, Thoracic endovascular aortic repair, Ulcer-like projections, Penetrating atherosclerotic ulcer, Intramural blood pools

中图分类号:

R543.1

赵文鹏,吕凡振,胡义良,陈晒,方华强,王世知,周为民. Stanford B型主动脉壁间血肿单中心治疗经验[J]. 山东大学学报 (医学版), 2024, 62(9): 108-114.

ZHAO Wenpeng, LYU Fanzhen, HU Yiliang, CHEN Shai, FANG Huaqiang, WANG Shizhi, ZHOU Weimin. Single-center experience in treatment of Stanford type B aortic intramural hematoma[J]. Journal of Shandong University (Health Sciences), 2024, 62(9): 108-114.

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