妊娠合并主动脉夹层6例回顾性分析

Aortic dissection during pregnancy:A retrospective analysis of 6 patients

摘要:

目的 探讨妊娠合并主动脉夹层的临床表现、诊断及治疗。方法 选取河南省人民医院于2015年1月至2020年12月收治的妊娠合并主动脉夹层患者6例,对其临床资料、治疗方案和母儿结局进行回顾性分析,探讨不同手术时机对妊娠合并主动脉夹层结局的影响。结果 6例年龄30~38岁,平均32.16岁。发病时间为孕5周至产后1个月,孕早期发病2例,孕晚期发病3例,产褥期发病1例。主要症状以胸背痛为主4例,以胸痛、气促为主1例,以腰痛为主1例。6例均行主动脉血管造影确诊,其中主动脉夹层类型为Stanford A型4例,Stanford B型2例。6例均行主动脉手术,主动脉手术与终止妊娠同时进行3例(切除子宫1例,保留子宫2例),主动脉手术后终止妊娠(先行Bentall术,术后1周行人工流产)2例,于产褥期行主动脉手术1例。术后产妇均存活,除2例行人工流产术外其余4例胎儿均存活,且随访期内母儿结局良好。结论 妊娠合并主动脉夹层的治疗,应结合主动脉夹层的范围、类型、胎儿孕周、孕妇的生育意愿进行充分评估,选择合适的手术时机,确保母儿安全,降低母儿病死率。

Abstract:

Objective To explore the clinical manifestations,diagnosis and treatment of aortic dissection during pregnancy.Methods A retrospective analysis of clinical data,auxiliary examination,therapeutic regimen,maternal-fetal outcomes of 6 pregnancy patients complicated with aortic dissection,who admitted to the Henan Provincial people's Hospital from January 2015 to December 2020 was performed,in order to explore the influence for the outcome on different operation time.Results Those patients ranged 30 to 38 years,with mean age 32.16 years;age at the the time of onset ranged from 5-week pregnancy to 1-month postpartum;there were 2 cases in first trimester,3 cases in third trmester,and 1 case in the puerperium.The cardinal symptom included 4 cases of pain in chest and back,1 case of hest pain and panting,and 1 case of low back pain.All patients perpormed aortic angiography,in term of classification of aortic dissection,4 cases were Stanford type A,and 2 cases were Stanford type B.All patients underwent aortic surgery,simultaneous aortic surgery and pregnancy termination were performed in 3 case(1 case of hysterectomy and 2 cases of retained uterus);the pregnancy was terminated after aortic surgery in 2 cases(Bentall surgery first,pregnancy termination on week 1 postoperative);aortic surgery was performed in 1 case during the puerperium.No postoperative mortality was reported.There were 2 fetuses of induced abortion,and 4 fetuses of surviver with good follow-up maternal-fetal outcome.Conclusion For aortic dissection during pregnancy,the treatment regimen should be fully evaluated the scope and type of aortic dissection,the gestational age of the fetus,and the pregnant woman's willingness.The appropriate timing of surgery should be selected to ensure the safety of mother and fetus,and futher reduce the mortality rate.