B型胸主动脉夹层动脉瘤的治疗策略.ppt

TheTherapeuticStrategyforTypeBThoracicAorticDissectionPeople’sHospital,PekingUniversity北京大学人民医院XieJiyan(解基严),etal,

TheTherapyforTypeBThoracicAorticDissectionMedicalSurgicalEndovascular

ClinicalMaterialMale74Famale4Age:55~73yHypertension:51CAD:4Chronicrenalinsufficiency:4Diabetesmellitus41990~2005Chronicpulmonaryocclusiondisease:19

78casesAcute34Chronic44ClinicalMaterial

ChestPainHeart\renal\lungSymptoms(ShortBreath)Pulse:Decreased（60%）BP:NormalorHighSymptomsSigns

DiagnosisMethodsEchocardiogram(TTETEE)CTMRIAngiography

SurgicalTherapy（48）MedicalTherapy（30）Localresectionpatch2Prostheticvesselreplacement3EndovascularStent15Actue（17）Chronica（31）Prostheticvesselreplacement14EndovascularStent14

48Localresectionpatch00/2Prostheticvesselreplacement32/14EndovascularStent0/140/15EmergencySelectiveAMIBleedingResults:operativemortality

Onestent21Twostents6Results:NooperativedeathComplications:Leak2Threestents1

Rupture：4/6Trachea：1Esophagus：1Chest：2Latetermdeath：8Results:MedicalTherapymortality（30）

Results:Long-termProstheticvesselreplacement12(1~7years):Hoarse3/5Death2EndovascularStent29(3mon.~4years):Nocomplicationsdeath

OneyearafterimplantStent

Discussion

MedicalvsSurgical?TheTimeofSurgery：EmergencyvsSelective?OperativeMethods：ConventionalvsEndo?TheTherapyforTypeBThoracicAorticDissection

COBPTheTherapyforTypeBThoracicAorticDissectionMedicalTherapyVascularDilatorCalciumantagonist?—Blocker

TheComplicationsofSurgeryTraumaAnesthesiaBleedingSpinalin