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Analysis of the Reason of the Misdiagnosis about Three Aortic Dissections

目的:探讨主动脉夹层患者误诊的原因,提高主动脉夹层患者的早期诊断率,为及时、正确救治患者生命提供有力的科学依据。方法:回顾性分析3例主动脉夹层患者实际诊断与误诊的情况,查明误诊原因。结果:3例主动脉夹层患者经检查后证实,1例误诊为急性食道撕裂伤或消化性溃疡,占33.33%;1例误诊为急腹症,占33.33%;1例误诊为急性颅内病变,占33.33%。结论积极评估其病情的危险程度,监测生命体征,快速建立静脉通道,同时仔细询问相关病史,认真查体,积极采取相应辅助检查,可降低误诊率。

胸主动脉瘤及主动脉夹层外科治疗进展

胸主动脉瘤及主动脉夹层病情凶险,死亡率和病残率均很高.近几年在保留和不保留主动脉瓣的主动脉根重建术治疗升主动脉瘤,弓部主动脉瘤切除与脑保护,胸主动脉瘤或胸腹主动脉瘤切除与脊髓保护,以及主动脉腔内支架移植术等方面取得了较大的进展.手术死亡率已从31.4%下降至3.3%～4.8%.胸主动脉瘤,特别是主动脉夹层系一全身性主动脉病变,近年来手术疗效有所改善,但远期复发率和再手术率仍较高.主动脉内支架移植与外科手术结合应用,对复杂的伴有降主动脉病变的A型主动脉夹层治疗,可能是一种安全而有效的方法.

A型主动脉夹层动脉瘤的外科治疗

目的 总结1996年1月至2002年8月收治的34例A型主动脉夹层动脉瘤的外科治疗经验. 方法 应用Bentall手术19例,升主动脉人工血管置换术7例,升主动脉人工血管置换加主动脉瓣成形术(Trusler’s法)5例,分别行升主动脉人工血管置换及主动脉瓣置换术(Wheat术)2例,升主动脉、主动脉弓人工血管置换术1例. 结果 手术死亡6例,死亡率17.6%.其中慢性主动脉夹层动脉瘤死亡3例,急性夹层动脉瘤死亡3例.随访20例,随访率71.4%.随访时间2～46个月,平均24.7个月,1例术后3个月猝死(原因不明),1例术后6个月死于心内膜炎.18例存活患者情况良好. 结论 应根据夹层动脉瘤的部位及范围采用不同的手术方式,保留主动脉瓣的升主动脉人工血管置换术治疗该病效果较好,准确可靠的吻合技术、保留瘤壁的完整性,将使手术更为安全.

深低温停循环重力脑逆行灌注在主动脉瘤手术中的脑保护作用

目的 探讨深低温停循环重力脑逆行性灌注技术在主动脉夹层动脉瘤手术中对脑和脊髓的保护作用。方法 建立体外循环后，开始降温。肛温17℃时，患者深度头低位(deep trendelenburg position)。控制股静脉回流, 股动脉流量降至1.5 L/min，升高和维持中心静脉压在20～23 cmH2O（1kPa=10.2 cmH2O)，即可完成脑逆行性灌注。结果 本组2例患者停循环脑逆行性灌注时间分别为50分钟和116分钟，术后未发生神经系统并发症。结论 深低温停循环重力脑逆行性灌注技术操作简单,能够充分暴露术野，对脑和脊髓有很好的保护作用。

Surgical treatment of retrograde type A aortic dissection after thoracic endovascular aortic repair for Stanford type B aortic dissection

Objective To analyze the etiologies, surgical treatment and outcomes of retrograde type A aortic dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection. Methods The clinical data of patients with RTAD after TEVAR for Stanford type B aortic dissection receiving operations in Changhai Hospital from March 2014 to August 2018 were analyzed. All patients were followed-up by clinic interview or telephone. Results A total of 16 patients were enrolled, including 13 males and 3 females with a mean age of 49.1±12.2 years. The main symptoms of RTAD were chest pain in 12 patients, headache in 1 patient, conscious disturbance in 1 patient, and asymptomatic in 2 patients. All the 16 patients received total arch replacement with the frozen elephant trunk technique. Bentall procedure was used in 2 patients, aortic root plasticity in 10 patients and aortic valve replacement in 1 patient. The primary tear in 10 patients was located in the area which were anchored by bare mental stent, and in the other 6 patients it was located in the anterior part of ascending aorta. The mean cardiopulmonary bypass time was 152.2±29.4 min, aortic cross-clamping time was 93.6±27.8 min and selective cerebral perfusion time was 29.8±8.3 min. There was no death in hospital or within postoperative 30 days. The follow-up period was 32-85 (57.4±18.3) months. No death occurred during the follow-up period. One patient underwent TEVAR again 3 years after this operation and had an uneventful survival. Conclusion Total arch replacement with the frozen elephant trunk technique is a suitable strategy for the management of RTAD after TEVAR for Stanford type B aortic dissection.

Time Distribution in the Occurrence of Acute Aortic Dissection

【摘要】　目的　研究急性主动脉夹层时间分布规律。　方法　回顾性研究我院2000年1月-2010年12月所有急性主动脉夹层患者的时间资料，分析其月份、季节、周以及时刻分布特点。　结果　急性主动脉夹层月份分布高峰点为1月4日，高峰段为9月21日～次年4月19日（Plt;0.05）；季节分布以冬春季较多（Plt;0.05）；周分布无高峰点及高峰段（Pgt;0.05）；时刻分布高峰点为上午10点及下午4点。　结论　急性主动脉夹层具有明显的时间分布规律，我们应该在该病的高峰时间更加重视其发生的可能，从而减少误诊，改善预后。【Abstract】　Objective　To investigate the features of time distribution in the occurrence of acute aortic dissection (AAD). 　Methods　We retrospectively analyzed all the databases of AAD in our hospital between January 1, 2000 and December 31, 2010, and studied the monthly, seasonal, weekly, and circadian distribution of the cases.　Results　In terms of monthly distribution, the occurrence of AAD peaked at January 4th with the high frequency in the period of September 21st to April 19th of the next year (Plt;0.05). According to the seasonal distribution, the occurrence of AAD peaked in winter and spring (Plt;0.05). There was no peak time in weekly distribution (Pgt;0.05). In accordance with circadian distribution, the occurrence of AAD peaked at 10 and 16 o’clock (Plt;0.05).　Conclusion　Because of the obvious rhythm of time distribution of AAD, We can pay more attention to the diagnosis of AAD especially in the peak time, thus reducing the mistakes in diagnosis and improving the prognosis.

Diagnostic Value and Clinical Application of Multi-slice Spiral CT Angiography in Aortic Dissection

目的　探讨多层螺旋CT血管造影（CTA）在主动脉夹层中的诊断价值及临床应用。 方法　回顾性分析2010年2月－2011年4月35例行CTA检查的主动脉夹层患者，所有患者原始数据在图像后处理工作站采用多平面重建、容积再重建、最大密度投影等方法进行主动脉成像。由2名有经验的放射科副主任医师进行诊断。 结果　35例均可明确显示主动脉夹层的真假腔、内膜片及破裂口部位。Ⅰ型12例，Ⅱ型3例，Ⅲ型20例；累及左锁骨下动脉5例，左颈总动脉2例，无名动脉2例，腹腔干3例，肠系膜上动脉4例，左肾动脉3例，右肾动脉2例，右髂总动脉受累6例，左髂总动脉受累8例，其中双侧髂总动脉均受累4例；合并动脉瘤3例；壁内血肿4例；所有患者均显示了单一或多发破口。 结论　CTA及图像后处理技术能快速、准确地诊断主动脉夹层，为临床治疗方案选择提供重要的影像学依据。

主动脉夹层动脉瘤支架置入术中血钾浓度异常增高二例

单下肢瘫痪为首发症状的急性主动脉夹层一例

【摘要】 目的 报道1例以单下肢瘫痪为首发症状的急性主动脉夹层患者。方法 2008年12月17日收治1例以单下肢瘫痪为首发症状的急性主动脉夹层患者入院。结果 急性主动脉夹层(acute aortic dissection,AAD)起病凶险，临床表现多样，经常伴发有神经系统症状。如合并脊髓缺血报道较少，可出现急性瘫痪，以截瘫为多见。〖HTH〗结论〖HTSS〗 急性主动脉夹层可以表现单侧肢体瘫痪为首发症状，临床上比较少见。

The clinical results of partial aortic root remodeling for root reconstruction on Stanford type A aortic dissection

Objective To analyze the clinical effect of partial aortic root remodeling for root reconstruction on Stanford type A aortic dissection. Methods From January 2010 to December 2015, 30 patients (25 males, 5 females) underwent partial aortic root remodeling for root reconstruction on Stanford type A aortic dissection with involvement of aortic root. The range of age was from 27 to 72 years, and the mean age was 51.2±8.0 years. The proximal aortic dissection received partial aortic root remodeling, and the operation procedures included partial aortic root remodeling+ascending aortic replacement in 9 patients, partial aortic root remodeling+ascending aortic replacement+hemi-arch replacement in 6 patients, partial aortic root remodeling+ascending aortic replacement+Sun's procedure in 15 patients. The patients were followed up for 10 to 60 months with a mean of 37.9±3.2 months. Preoperative and postoperative degrees of aortic regurgitation were compared. Results All patients survived from the operation, and one patient died from severe pulmonary infection 15 days after operation. The overall survival rate was 96.7% (29/30). One patient died during the follow-up. Two patients underwent aortic valve replacement in the 12th and 15th postoperative month respectively because of severe aortic regurgitation (AI). Up to the last follow-up, trivial or no aortic regurgitation was demonstrated in 24 patients, but mild aortic regurgitation occurred in 2 patients. Conclusion The surgical treatment for aortic root pathology due to Stanford type A aortic dissection is challenging, and partial aortic root remodeling operations could restore valve durability and function, and obtains the early- and mid-term results.