Asakuma S, Terawaki K, Yamamoto J, Kawakami K, Mihata S, Yasutomi N, Fujitani K, Iwasaki T, Yamashita K, Miyamoto T
First Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya.
J Cardiol. 1990;20(2):369-75.
The medical and surgical treatment of 96 patients of dissecting aneurysms was reviewed. There were 42 patients with Stanford type A dissecting aneurysms, 19 of whom received medical treatment and 23 of whom had surgical treatment. Among 54 patients with Stanford type B dissecting aneurysms, 24 had medical and 30 had surgical treatments. The treatment results and the long-term outcomes were studied using the Kaplan-Meier method, categorizing the subjects in non-survivor (in-hospital) and survivor groups. The results indicated that those with surgical treatment had a higher survival rate (75%) in the early post-operative course, for both type A and type B aneurysms. However, the long-term outcome of the survivor group was not different between type A and type B aneurysms regardless of type of treatment. Fifty-six percent of cases with type A aneurysms with serious complications survived by medical treatment alone, and no intimal tears were visualized on angiogram. Therefore, it was suggested that, in patients who had no angiographically defined intimal tears in the acute phase, medical treatment may be more effective, even for type A dissecting aneurysms.
回顾了96例夹层动脉瘤患者的内科及外科治疗情况。其中有42例斯坦福A型夹层动脉瘤患者，19例接受内科治疗，23例接受外科治疗。在54例斯坦福B型夹层动脉瘤患者中，24例接受内科治疗，30例接受外科治疗。采用Kaplan-Meier方法研究治疗结果及长期预后，将受试者分为非幸存者（院内）和幸存者组。结果表明，对于A型和B型动脉瘤，接受手术治疗者在术后早期的生存率较高（75%）。然而，无论治疗方式如何，A型和B型动脉瘤幸存者组的长期预后并无差异。56%有严重并发症的A型动脉瘤病例仅通过内科治疗存活，血管造影未显示内膜撕裂。因此，有人提出，对于急性期血管造影未发现内膜撕裂的患者，即使是A型夹层动脉瘤，内科治疗可能更有效。
