Thenabadu P N, Steiner R E, Cleland W P, Goodwin J F
Postgrad Med J. 1976 Nov;52(613):671-7. doi: 10.1136/pgmj.52.613.671.
The results are presented of treatment in twenty-three patients with dissection of the thoracic aorta, in four of whom it was acute (less than 14 days' duration), and in nineteen chronic (more than 14 days' duration). Sixteen patients had Type I and II dissection (involving the ascending aorta) and five Type III (descending aorta at or distal to the origin of the left subclavian artery); in two, dissection complicated coarctation of the aorta in the usual site. Thirteen patients had aortic regurgitation. Three of the patients with acute dissection were treated medically; two, both with Type I dissection, died, and the third, with Type III, survived. The remaining acute patient was treated surgically and also died. Of the patients with chronic dissection, eight were treated medically and eleven surgically. None of the medical group died in hospital; three died between 3 months and 1 year, and five have survived from periods of 12-72 months. Eleven patients with chronic dissection were treated surgically; four died in hospital at or shortly after operation; and the remaining seven lived for periods of 12-84 months. The presentation, indications for surgical treatment and results are discussed. It is concluded that surgical treatment of chronic dissection may carry a higher initial mortality than medical, but that there may be slightly better overall long term results in the former. As this series was not selected randomly, because patients with complications were selected for surgery, and there are only a few patients in each group, the results do not permit firm conclusion regarding the relative merits of medical and surgical treatment. It is suggested that all patients should initially be treated medically but that surgical treatment should be considered if the dissection continues, if aortic regurgitation is severe, if an aneurysm develops or enlarges, if cardiac tamponade develops or there is evidence of progressive involvement of the branches of the aorta. Attention is drawn to the important syndrome of chronic dissecting aneurysm of the ascending aorta with severe aortic regurgitation which requires definitive surgical treatment and aortic valve replacement. The importance of adequate visualization of the origin and extent of the dissection as a preliminary to surgical treatment is stressed.
本文呈现了23例胸主动脉夹层患者的治疗结果，其中4例为急性夹层（病程小于14天），19例为慢性夹层（病程超过14天）。16例患者为I型和II型夹层（累及升主动脉），5例为III型夹层（左锁骨下动脉起始处或其远端的降主动脉）；2例夹层合并主动脉常见部位的缩窄。13例患者有主动脉瓣反流。3例急性夹层患者接受内科治疗；2例I型夹层患者死亡，第3例III型夹层患者存活。其余急性夹层患者接受手术治疗，也死亡。慢性夹层患者中，8例接受内科治疗，11例接受手术治疗。内科治疗组无患者在医院死亡；3例在3个月至1年之间死亡，5例存活12 - 72个月。11例慢性夹层患者接受手术治疗；4例在手术时或术后不久在医院死亡；其余7例存活12 - 84个月。讨论了临床表现、手术治疗指征及结果。结论是，慢性夹层的手术治疗初始死亡率可能高于内科治疗，但前者的总体长期结果可能略好。由于本系列不是随机选择的，因为有并发症的患者被选来进行手术，且每组患者数量较少，所以这些结果不允许就内科和手术治疗的相对优缺点得出确凿结论。建议所有患者最初应接受内科治疗，但如果夹层持续、主动脉瓣反流严重、动脉瘤形成或增大、发生心脏压塞或有主动脉分支进行性受累的证据，则应考虑手术治疗。提请注意升主动脉慢性夹层动脉瘤伴严重主动脉瓣反流这一重要综合征，其需要确定性手术治疗及主动脉瓣置换。强调了在手术治疗前充分明确夹层起源和范围的重要性。
