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1、血管腔内治疗B型胸主动脉夹层伴A型壁内血肿3例宋松林熊斌郑传胜阚雪锋钱坤冯敢生华中科技大学同济医学院附属协和医院放射科摘要：目的探讨胸主动脉腔内修复术(TEVAR)治疗StandfordB型夹层伴A型壁内血肿(MH)的安全性及有效性。方法2015年10月至2017年1月共收治3例B型夹层伴A型MH患者，入院后稳定血压、心率，对症保守治疗14d后行TEVAR术。结果3例患者均顺利完成TEVAR术，无逆撕等并发症。术后1个月全主动脉CTA复查显示夹层破口完全封闭，无内漏发生，真腔血流明显改善，壁内血肿明显吸收消退
2、，升主动脉管壁厚度恢复至正常水平;患者临床症状明显好转，无截瘫、死亡等严重并发症发生。结论对伴发升主动脉MH的StanclforclB型胸主动脉夹层，如果升主动脉内膜完整，降压、降心率处理后症状缓解，在发病Md后行TEVAR术是安全有效的。关键词：胸主动脉腔内修复术;StandfordB型胸主动脉夹层;A型壁内血肿;作者简介：熊斌E-ina订:herrxiong@126.com收稿日期：2017-01-31EndovascularrepairofStandfordtypeBthoracicaorticdiss
3、ectioncomplicatedbytypeAintramuralhematoma:preliminaryresuItsin3pa/tientsSONGSonglinXIONGBinZHENGChuanshengKANXuefengQIANKunFENGGanshengDepartmentofRadiology,UnionHospital,TongjiMedicalCollege,HuazhongUniversityofScienceandTechnology;Abstract：ObjectiveToeva
4、luatethesafetyandeffectivenessofthoracicendovascularaorticrepair(TEVAR)intreeitingStemdfordtypeBthoracicaorticdisscctioncomplicatedbytypeAintramuralhematoma.MethodsFromOctober2015toJanuary2017,atotalof3patientswithStandfordtypeBthoracicaorticdissectioncompl
5、icatedbytypeAintramuralhematomawereadmittedtoauthors'hospitaltoreceivetreatment.Afteradmission,conservativetreatmentsuchasstabi1izingbloodpressureandheartrate,symptomaticmedication,etc.werecarriedoutfor14days,then,TEVARwasperformed.ResuItsSuccessfulTEVARwas
6、accomplishedinall3patients,noseriouscomplications,suchasreversetear,occurred.OnemonthafterTEVAR,reexaminationoftotalaorticCTangiographyrevealedthattheruptureofdissectionwascompletelyclosedwithnointernalleakage,thebloodflowinthetruelumcnwasobviouslyimproved,
7、theintramuralhematomawasremarkablyabsorbedandfadedaway,andthewallthicknessofascendingaortareturnedtonormalrange.Theclinicalsymptomsweregreatlyimproved,noseriouscomplicationssuchasparaplegiaordeathoccurred.ConclusionForthetreatmentofStandfordtypeBthoracicaor
8、ticdissectioncomplicatedbytypeAintramuralhematoma,TEVARperformedat14daysaftertheonsetofdiseaseissafeandeffectiveiftheascendingaortaintimaisintactandtheclinicalsymptomsarerelivedaftermedicationoflowerin
