| 摘要: |
| 目的 总结妊娠合并Stanford A型主动脉夹层的外科治疗经验,并评价其安全性和疗效。方法 回顾性分析2012年4月至2018年9月四川省医学科学院?四川省人民医院2例妊娠合并Stanford A型主动脉夹层患者经外科手术治疗的临床资料。2例患者均同期行主动脉根部置换+Sun’s手术+剖宫取胎术。结果 2例母体均存活；例1术后并发肺部感染,例2术后并发急性脊髓缺血导致的右下肢体活动受限和骶尾部褥疮,经过积极治疗均好转出院；2例胎儿死亡。术后随访2～11个月,心脏彩超提示主动脉瓣位人工瓣膜未见明显异常；主动脉CTA提示手术部位形态、结构、血流未见异常,支架远端的自体血管无扩张,假腔血栓机化形成；例1产妇恢复工作,例2产妇右下肢体肌力恢复至Ⅳ级。结论 妊娠合并Stanford A型主动脉夹层的患者应积极手术治疗,根据主动脉病理改变、孕周、胎儿宫内情况及患方意愿决定具体手术方式。 |
| 关键词: 妊娠 主动脉夹层,Stanford A型 手术治疗 |
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| 基金项目:中国科学院2014年度“西部之光”人才培养计划资助课题(编号：30305031013) |
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| Surgical management of two cases of Stanford type A aortic dissection associated with pregnancy and literature review |
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liushengzhong
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Sichuan Academy of Medical Sciences ＆ Sichuan Provincial People’s Hospital, Sichuan Translational Medicine Hospital, Chinese Academy of Sciences
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| Abstract: |
| Objective To summarize the clinical experience of surgical management of Stanford type A aortic dissection associated with pregnancy, and evaluate its safety and efficacy. Methods Clinical data of 2 patients with Stanford type A aortic dissection associated with pregnancy who received concurrentty aortic root replacement with Sun’s procedure (total arch replacement combined with stented elephant trunk implantation) and hysterotomy delivery in Sichuan Academy of Medical Sciences ＆ Sichuan Provincial People’s Hospital from April 2012 to September 2018 were retrospectively analyzed. Results Case 1 suffered from postoperative pulmonary infection. Case 2 was complicated with extremity movement restriction of the right lower limb caused by acute spinal cord ischemia injury and sacrococcygeal bedsore. Both women patients were improved and discharged after active treatment, but 2 cases of fetus died. The 2 surviving patients were followed up for 2 to 11 months after discharge. No obvious abnormality of the prosthetic valve in aortic valve position was found by transthoracic echocardiography. Aortic computed tomography angiogram detected normal aortic and valvular structure, without signs of distal dilation and with organized thrombus in the aortic false lumen. Case 1 recovered well and went to work. The body strength of right lower limb in case 2 was restored to grade Ⅳ. Conclusion Patient with of Stanford type A aortic dissection associated with pregnancy should be operated actively. The optimized surgical management should be decided according to the pathological changes of aorta, gestational week, fetal intrauterine condition and the wish of the patient. |
| Key words: Pregnancy Stanford type A aortic dissection Surgical management |
