主动脉穿透性溃疡的临床特点与治疗方法

尤家运; 余朝文; 聂中林; 高涌; 卢冉; 王强; 王辰萌

doi:10.16766/j.cnki.issn.1674-4152.001915

主动脉穿透性溃疡的临床特点与治疗方法

doi: 10.16766/j.cnki.issn.1674-4152.001915

蚌埠医学院第一附属医院血管外科，安徽蚌埠 233004

基金项目:

安徽省科技攻关项目 201904a07020020

详细信息

通讯作者:
聂中林, E-mail: niezl988@sina.com

中图分类号: R543.1
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出版历程
- 收稿日期: 2020-09-25
- 网络出版日期: 2022-02-16

Clinical characteristics and treatment of penetrating aortic ulcer

Department of Vascular Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的分析并总结主动脉穿透性溃疡(penetration aortic ulcer，PAU)患者的临床特点及治疗方法的选择。方法回顾性分析2016年1月—2019年11月蚌埠医学院第一附属医院血管外科收治的32例PAU患者的临床资料，其中保守治疗组12例，主动脉腔内修复(endovascular aneurysm repair，EVAR)组20例，对2组患者的临床特点及治疗效果进行分析。结果 EVAR组患者住院时间较保守治疗组短、入院时D-二聚体水平较保守治疗组高(均P＜0.05)，EVAR组患者溃疡直径、溃疡深度及并发主动脉壁内血肿(intramural hematoma，IMH)与保守治疗组相比较，差异有统计学意义(均P＜0.05)，其他方面差异均无统计学意义(均P＞0.05)。近期随访中保守治疗组患者新发主动脉夹层的发生率高于EVAR组，差异有统计学意义(P＜0.05)，中远期随访中2组间溃疡增大、新发主动脉夹层的发生率EVAR组均略低于保守治疗组，但差异无统计学意义(P=0.089、0.089)，其他指标相比差异均无统计学意义(均P＞0.05)。结论 EVAR治疗PAU是一种安全、有效的方法，与保守治疗相比较，可降低近期主动脉夹层发生率。对于持续性疼痛症状、合并IMH以及有主动脉破裂征象的患者建议积极行EVAR治疗。
- 主动脉穿透性溃疡 /
- 主动脉壁内血肿 /
- 临床特点 /
- 主动脉腔内修复术 /
- 疗效
Abstract: Objective To analyse and summarise the clinical characteristics of patients with penetrating aortic ulcer (PAU) and the choice of treatment. Methods Clinical data of 32 PAU patients admitted to the Vascular Surgery Department of the First Affiliated Hospital of Bengbu Medical College from January 2016 to November 2019 were retrospectively analysed, including 12 cases in the conservative treatment group and 20 cases in the endovascular aneurysm repair (EVAR) group. The clinical characteristics and therapeutic effects of the two groups were analysed. Results The hospital time of the patients in the EVAR group was short compared with the conservative treatment group (all P < 0.05). The D-dimer level, ulcer diameter, depth of the ulcer and concurrent aortic intramural hematoma (intramural hematoma, IMH) of the EVAR group were higher compared with those of the conservative treatment group, and the differences were statistically significant (all P < 0.05). No statistically significant differences were observed in the other areas (all P>0.05). Recent follow-up on new conservative treatment group patients showed that the incidence of aortic dissection was higher than that in the EVAR group, and the difference was statistically significant (P < 0.05). Long-term follow-up showed that the risk of ulcer increases for the two groups. The incidence of new aortic dissection for the EVAR group was slightly lower than that for the conservative treatment group, but there was no statistically significant difference (P=0.089, 0.089). Other indicators had no statistically significant differences (all P>0.05). Conclusion EVAR is a safe and effective method in the treatment of PAU as it can reduce the incidence of recent aortic dissection compared with the conservative treatment. EVAR is recommended for patients with persistent pain symptoms, combined IMH and signs of aortic rupture.
- Penetrating aortic ulcer /
- Intramural hematoma /
- Clinical feature /
- Endovascular aneurysm repair /
- Curative effect

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表 1 2组PAU患者临床资料对比[例(%)]

组别	例数	性别(男/女，例)	年龄(x±s，岁)	吸烟史	既往病史				临床症状
组别	例数	性别(男/女，例)	年龄(x±s，岁)	吸烟史	高血压病	冠心病	糖尿病	肾脏疾病	胸痛	背痛	腹痛	无症状
保守治疗组	12	7/5	69.67±12.64	2(16.7)	9(75.0)	2(16.7)	1(8.3)	2(16.7)	8(66.7)	6(50.0)	1(8.3)	3(25.0)
EVAR组	20	17/3	66.35±11.95	8(40.0)	16(80.0)	2(10.0)	2(10.0)	2(10.0)	15(75.0)	8(40.0)	3(15.0)	2(10.0)
t值			0.745
P值		0.116^a	0.462^a	0.248^a	0.999^a	0.620^a	0.999^a	0.620^a	0.696^a	0.718^a	0.999^a	0.338^a

组别	例数	收缩压(x±s，mm Hg)		舒张压(x±s，mm Hg)		甘油三酯(x±s，mmol/L)		总胆固醇(x±s，mmol/L)	D-二聚体(x±s，mg/L)	住院天数(x±s，d)		医疗费用(x±s，元)
保守治疗组	12	154.58±18.53		90.17±11.14		2.31±2.64		3.92±1.00	0.81±0.70	24.25±5.38		18 592.96±7 008.06
EVAR组	20	153.75±27.25		87.50±14.00		1.63±0.87		4.26±1.16	3.73±5.64	19.60±6.52		129 036.77±42 740.81
t值		0.093		0.561		0.865		0.843	2.286	2.079		11.306
P值		0.926		0.579		0.404		0.406	0.033	0.046		< 0.001
注：^a为采用Fisher精确检验。

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表 2 2组PAU患者影像学资料对比[例(%)]

组别	例数	主动脉弓部溃疡	降主动脉溃疡	腹主动脉溃疡	胸腔积液	并发IMH	溃疡直径(x±s，mm)	溃疡深度(x±s，mm)	主动脉弓参考直径(x±s，mm)
保守治疗组	12	0(0.0)	10(83.3)	2(16.7)	2(16.7)	2(16.7)	12.17±3.35	8.58±1.38	28.33±2.15
EVAR组	20	2(10.0)	15(75.0)	3(15.0)	2(10.0)	14(70.0)	18.90±10.13	14.30±6.71	28.60±1.64
t值							2.733	3.685	0.401
P值		0.516^a	0.683^a	0.999^a	0.620^a	0.009^a	0.011	0.001	0.691
注：^a为采用Fisher精确检验。

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表 3 2组PAU患者近期随访结果比较[例(%)]

组别	例数	血压控制不佳	冠心病	脑卒中	肾功能不全	溃疡增大	新发主动脉夹层	全因死亡	主动脉破裂死亡	其他原因死亡
保守治疗组	12	2(16.7)	0(0.0)	1(8.3)	0(0.0)	0(0.0)	3(25.0)	1(8.3)	1(8.3)	0(0.0)
EVAR组	20	5(25.0)	0(0.0)	1(5.0)	2(10.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)
P值		0.683		0.999	0.516		0.044	0.999	0.999

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表 4 2组PAU患者远期随访结果比较[例(%)]

组别	例数	血压控制不佳	冠心病	脑卒中	肾功能不全	溃疡增大	新发主动脉夹层	全因死亡	主动脉破裂死亡	其他原因死亡
保守治疗组	9	1(11.1)	1(11.1)	1(11.1)	1(11.1)	2(22.2)	2(22.2)	3(33.3)	2(22.2)	1(11.1)
EVAR组	20	3(15.0)	1(5.0)	1(5.0)	2(10.0)	0(0.0)	0(0.0)	2(10.0)	0(0.0)	2(10.0)
P值		0.999	0.532	0.532	0.999	0.089	0.089	0.287	0.089	0.999

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参考文献(16)

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