Management of patients with intramural hematoma involving the ascending aorta
Management of patients with intramural hematoma involving the ascending aorta
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DOI：
10.1067/mtc.2002.125637
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发表时间：
2002-11-01
影响因子：
6
通讯作者：
Tabayashi, K
中科院分区：
文献类型：
--
作者：
Moizumi, Y;Komatsu, T;Tabayashi, K
目的：虽然主动脉壁内血肿被认为是一种独特的病理实体，但涉及升主动脉（A 型）的壁内血肿的治疗尚未得到很好的确立。本研究的目的是建立A型壁内血肿的最佳治疗模式。方法：我们对A型壁内血肿患者进行如下治疗。早期手术仅针对心脏压塞、即将破裂或破裂的患者进行。其他患者接受了药物治疗，但在医疗随访期间壁内血肿进展的患者的治疗转为手术。自1992年2月至200年3月1，共有33例A型壁内血肿患者按本文所述进行治疗。根据初始治疗将患者分为早期手术组（n = 9）和药物治疗组（n = 24）。比较各组之间的临床资料以及住院和长期生存率。结果：与早期手术组相比，药物治疗组年龄更年轻（64.2 +/- 7.0 岁 vs 71.7 +/- 8.5 岁，P = .0319），受累节段数量更多（3.6 +/- 0.6 vs 3.0 +/- 0.9，P = .0395）。药物治疗组中的 8 名患者在随访期间因壁内血肿进展而转为手术治疗。早期手术组和内科治疗组的院内死亡率分别为 11% 和 5% (P = .477)。早期手术组的累积 1 年和 2 年生存率分别为 89% 和 89%，而药物组分别为 92% 和 81%（P = 0.49）。 结论：我们得出的结论是，约 70% 的 A 型壁内血肿可以得到预期治疗，超过 50% 可以仅通过药物治疗。
Objective: Although intramural hematoma of the aorta is considered a unique pathologic entity, the management of intramural hematoma involving the ascending aorta (type A) has not been well established. The purpose of this study was to establish the optimal mode of management of type A intramural hematoma.Methods: We treated patients with type A intramural hematoma as follows. Early operation was carried out only for patients with cardiac tamponade, impending rupture, or rupture. Other patients were treated medically, but patients with progression of intramural hematoma during medical follow-up had their treatment converted to surgery. From February 1992 to March 200 1, a total of 33 patients with type A intramural hematoma were treated as described here. Patients were divided according to initial treatment into an early surgery group (n = 9) and a medical treatment group (n = 24). Clinical profiles and in-hospital and long-term survival rates were compared between the groups.Results: Compared with the early surgery group, the medical treatment group was younger (64.2 +/- 7.0 years vs 71.7 +/- 8.5 years, P = .0319) and had a greater number of involved segments (3.6 +/- 0.6 vs 3.0 +/- 0.9, P = .0395). Eight patients in the medical treatment group were switched to surgery during follow-up because of progression of intramural hematoma. In-hospital mortality rates in the early surgery and medical groups were 11% and 5% (P = .477), respectively. Cumulative 1- and 2-year survivals were 89% and 89%, respectively, in the early surgery group, and 92% and 81%, respectively, in the medical group (P = .49).Conclusion: We concluded that about 70% of type A intramural hematomas could be managed expectantly, and more than 50% could be treated medically alone.