斯坦福B型急性大动脉剖析的结果
Circulation
|November 1, 1992
概括
斯坦福B型大动脉剖析手术的最佳时间被争论. 由于手术死亡率高,急性病例最好采用初始医疗管理,但对于动脉瘤扩张可能需要选择性手术.
科学领域:
- 心血管外科心血管外科
- 胸部外科手术 胸部外科手术
- 血管外科 血管外科
背景情况:
- 斯坦福B型大动脉剖析的管理仍然存在争议.
- 最佳的手术时间需要进一步调查.
- 对早期和长期结果的回顾性审查.
研究的目的:
- 为了评估斯坦福B型大动脉剖析的早期和长期结果.
- 为了比较医疗与手术管理的结果.
- 为了确定手术干预的最佳时间.
主要方法:
- 75名斯坦福B型大动脉剖析患者的回顾性分析 (1979年4月至1991年1月).
- 初始治疗:突发性破裂/即将破裂的紧急手术 (13名患者) 或医疗管理 (45名患者).
- 对结果的后续评估,包括死亡率和后续手术的需要.
主要成果:
- 紧急手术组:死亡率为69%.
- 接受医疗治疗的组:18%需要稍后的手术动脉瘤扩大/破裂,在这个子组中有13%的死亡率.
- 在医疗治疗后出院的患者中,11.9%的患者经历了破裂.
结论:
- 在急性斯坦福B型大动脉剖析中,医疗管理是可取的,除非存在重大并发症,因为手术死亡率高.
- 动脉瘤扩张需要手术是常见的,即使在初始成功的医疗治疗后.
- 在出现扩张迹象时应立即考虑选择性手术,以最大限度地降低破裂风险.
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