夹层主动脉瘤:临床病理研究。1 .临床及大体病理表现。

J. C. Leonard, P. Hasleton
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引用次数: 79

摘要

1951年至1976年间在曼彻斯特三家医院就诊的171名夹层动脉瘤患者接受了研究。近端解剖60例,远端解剖80例,腹部解剖10例,21例发病部位不确定。88%的患者以疼痛为主要症状;放射到肩胛间区的疼痛在远端剥离中更为常见。77%的患者存在全身性高血压,远端解剖(83%)比近端解剖(70%)更常见。主动脉功能不全、偏瘫和休克均多见于近端夹层。对125例患者进行尸检。84%的近端夹层破裂,74%进入心包,5%进入左胸膜腔。70%的远端夹层破裂,11%进入心包,41%进入左胸膜腔。解剖的程度进行了分析,并表明,25%的远端解剖延伸近端进入升主动脉和弓。这意味着从临床征象和胸片平片诊断剥离的起源部位是不准确的。需要主动脉造影进行精确评估。由于治疗方法往往随剥离部位的不同而不同,大多数存活几个小时的患者应进行主动脉造影。注意到多发主动脉病变的频率(10.4%),以及巨细胞动脉炎的偶然病因意义,可能还有甲状腺功能减退。
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Dissecting aortic aneurysms: a clinicopathological study. I. Clinical and gross pathological findings.
One hundred and seventy-one patients with dissecting aneurysm seen between 1951 and 1976 at three hospitals in Manchester were studied. There were 60 proximal dissections, 80 distal dissections, 10 abdominal dissections and in 21 the site of origin was uncertain. Pain was the major symptom in 88 per cent of patients; radiation of pain to the interscapular region was much more common in distal dissections. Systemic hypertension was present in 77 per cent, being commoner in distal dissections (83 per cent) than in proximal dissections (70 per cent). Aortic incompetence, hemiplegia and shock were all more common in proximal dissections. Post-mortem examination was performed in 125 patients. Eighty-four per cent of proximal dissections had ruptured, 74 per cent into the pericardium and five per cent into the left pleural cavity. Seventy per cent of distal dissections had ruptured, 11 per cent into the pericardium and 41 per cent into the left pleural cavity. The extent of the dissection was analysed, and it was shown that 25 per cent of distal dissections had extended proximally into the ascending aorta and arch. This implies that diagnosis of the site of origin of dissection from clinical signs and the plain chest-radiograph is inaccurate. Aortography is required for precise assessment. Since treatment often varies with the site of dissection, aortography should be performed in most patients surviving the first few hours. Attention is drawn to the frequency (10.4 per cent) of multiple aortic lesions, and to the occasional aetiological significance of giant-cell arteritis, and, possibly, hypothyroidism.
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the Quarterly Journal of Nuclear Medicine and Molecular Imaging
the Quarterly Journal of Nuclear Medicine and Molecular Imaging Medicine-Radiology, Nuclear Medicine and Imaging
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期刊介绍: The Quarterly Journal of Nuclear Medicine and Molecular Imaging publishes scientific papers on clinical and experimental topics of nuclear medicine. Manuscripts may be submitted in the form of editorials, original articles, review articles and special articles. The journal aims to provide its readers with papers of the highest quality and impact through a process of careful peer review and editorial work.
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