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在怀孕和产后期间A型大动脉剖析:在25年多的60名患者的经验
Jun-Ming Zhu1, Su-Wei Chen1, Wei-Guo Ma2
1Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing, China.
The Journal of thoracic and cardiovascular surgery
|January 11, 2026
概括
怀孕期间A型大动脉解剖 (TAAD) 的管理需要及时干预. 对于28周怀孕后的TAAD,分娩后进行大动脉修复,理想情况下是在一个阶段,改善了母亲和胎儿的生存率.
科学领域:
- 心血管外科心血管外科
- 孕产妇和胎儿医学 孕产妇和胎儿医学
- 大动脉疾病 大动脉疾病
背景情况:
- 在怀孕或产后期间A型大动脉解剖 (TAAD) 是一种罕见但危及生命的疾病.
- 最佳的管理策略平衡孕产妇和胎儿的结果仍在争论中.
研究的目的:
- 评估长期经验与管理的A型大动脉解剖 (TAAD) 在孕妇和产后妇女在25年的时间.
- 分析不同管理策略对孕产妇和胎儿存活率的影响.
主要方法:
- 在1998年至2023年期间对60名怀孕妇女进行了回顾性审查,这些妇女在1998年至2023年期间接受了TAAD治疗.
- 管理策略根据妊娠周进行分类,包括单阶段分娩和修复,分娩先,或主动脉修复先.
主要成果:
- 在98.3%的病例中使用了手术管理.
- 单阶段分娩和大动脉修复 (48.3%) 和分娩前后修复 (30%) 与修复前策略相比,显示出更好的孕产妇和胎儿存活率.
- 长期随访显示,母亲和胎儿的10年生存率分别为79.3%和67.7%.
结论:
- 对于28个妊娠周后的TAAD,最好采用结合分娩和大动脉修复的单阶段方法.
- 在怀孕28周之前的病例中,由于胎儿的结果不确定,优先考虑母亲的生存是至关重要的.
- 考虑怀孕的马方综合征妇女的预防性大动脉修复可能在较小的大动脉根直径 (≥45毫米) 的情况下有益.
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