摘要
目的总结在非主动脉夹层围手术期确诊降主动脉夹层的临床特点,探讨误诊、漏诊原因及应急治疗策略。方法回顾分析我院2001年1月—2010年12月11例在其他手术过程中或在围手术期发现的主动脉夹层患者的临床资料。结果胸外伤后开胸探查发现4例,反复胸穿后凝固性血胸行开胸探查发现1例,术前诊断急腹症术中发现腹主动脉夹层1例、术后发现4例,行椎间盘手术时造成医源性降主动脉夹层1例。全组在明确诊断后全麻下急诊手术治疗,行升主动脉置换+术中降主动脉覆膜支架植入1例、降主动脉人造血管置换术6例、降主动脉覆膜支架植入3例、降主动脉补片修补1例。本组均顺利完成主动脉置换或覆膜支架植入手术。1例原有肾脏病的患者在降主动脉置换术后出现急性肾功能衰竭,术后并发肺部感染3例,顽固性心律失常1例。全组无截瘫,无围手术期死亡,均痊愈出院。结论遭遇性降主动脉夹层或为误、漏诊病例或是易误诊、漏诊,给临床治疗带来困难,及时合理的人造血管置换或覆膜支架植入是应急处理的可靠、有效手段。
Objective To summarize the clinical characteristics of patients with descending aortic dissection diagnosed during peroperative period, and to explore the misdiagnosis causes and the strategies of emergent treatment. Methods The clinical data of 11 patients with descending aortic dissection diagnosed during non-aortic dissection surgery or peroperative period during January 2001 and December 2012 were retrospectively analyzed. Results The aortic dissection was diagnosed in 4 patients with thoracic trauma during exploratory thoracotomy, 1 patient with coagulating hemothorax after repeating thoracic paracentesis, 5 preoperative misdiagnosis patients with acute abdomen including 1 patient with abdominal dissection of aorta during operation and 4 patients diag- nosed after operation, and 1 patient with iatrogenic descending aortic dissection caused by intelwertebral disk surgery. All the pa- tients underwent emergency operation under general anesthesia after final diagnosis; one patient taking ascending aorta replacement and intraoperative descending aorta stent graft implantation, 6 patients taking descending aorta vascular prosthesis replacement, 3 patients taking descending aorta stcnt graft implantation and 1 patient taking descending aorta repair. The aortic replacement or membrana tectoria cochleae stent implantation was performed successfully in all the patients. One patient with preliminary renal disease suffered acute renal failure after operation, 3 patients had concurrency pulmonary infection, and 1 patient had refractory ar- rhythmia. There was no paraplegia and perioperative death, and all the patients recovered and were discharged. Conclusion Clinical diagnosis of the accidental descending aortic dissection is difficult. Timely rational prosthesis replacement or stent graft implantation is reliable and effective for emergent treatment.
出处
《临床误诊误治》
2013年第2期40-42,共3页
Clinical Misdiagnosis & Mistherapy
关键词
动脉瘤
夹层
降主动脉
主动脉置换
覆膜支架植入
误漏诊
Aneurysm, dissecting
Descending aorta
Aortal replacement
Mcmbrana tectoria cochleae stent implantation
Misdiagnosis
