| Objective: there is no consensus on the clinical treatment strategy of Stanford type A intramural hematoma in the world or even among regions.Doctors from European and American countries prefer surgical treatment,but A number of studies in Asian countries such as Japan and South Korea have proposed that most of type A IMH can be treated with drugs,and only high-risk patients need surgical treatment.At present,there is no specific medical guidelines to regulate the diagnosis and treatment of this type of disease in China.In this study,the relevant cases in tongji hospital in previous six years were analyzed retrospectively,so as hope to develop relevant clinical guidelines in the future and provide clinicians with relevant treatment experience and certain single-center data.Methods: by retrospective collection and systemic analysis related to the patient's hospitalization information and follow-up data,from January 2012 to December 2017,there are 55 cases in the six years in tongji hospital,huazhong university of science and technology,after confirmed by CTA on admission can be divided into different groups(emergency surgery group,early progress group after drug treatment,long-term progress group after drug treatment,stable group after drug treatment).SPSS software was used for statistical analysis of the data,where the measurement data is represented as mean±standard deviation,Student's t test is used for test,and the counting data is represented as examples and percentages,as well as the chi-square test or Fisher's exact test.According to the level that ?=0.05,The difference was considered statistically significant if P < 0.5.Results: 13 patients received emergency surgical treatment(including conventional aortic replacement and hybrid surgery)immediately after admission and diagnosis,and 2 died within 30 days after surgery.The remaining 42 patients were treated with symptomatic relief,and CTA was reviewed at least once a week during hospitalization.According to the comparison of imaging data,13 patients showed early progression,with an average of 8.0±3.9 days,and 3 of them died early after refusing surgical treatment.Ten patients received surgical treatment,and the average number of confirmed operation days since admission(8.7±3.8 days),with one postoperative death.There were 29 patients in the stable group without surgical treatment.During the follow-up period,no long-term progression or death occurred in the survival patients in the initial emergency surgery group.There was also no long-term progression or death in the patients who survived the initial drug therapy followed by timely surgery,but 4 patients who had been on the drug therapy showed progression after 30 days,3 of whom had died.There was no significant difference in early mortality(30 days)and long-term mortality(> 30 days)between initial emergency surgical treatment and initial drug treatment.A total of 13 patients with early progression after initial drug therapy,3 of whom refused surgical treatment.In addition,10 patients received timely surgical treatment,and 1 patient died in the early postoperative period,with no statistically significant difference compared with the early postoperative mortality of emergency surgery.Although the proportion of arch involved in the surgical process of late and timely surgery was less than that of emergency surgery(20%,38.5%),there was no statistically significant difference between the two ways.There were 17 cases of early progress(13cases)and long-term progress(4 cases)in patients receiving initial drug treatment,which were collectively referred to as the progress group;those without early progress and late progress were referred to as the stable group.A total of 17 patients with the initial largest aorta diameter greater than 50 mm,including 11 patients with progression and 6 patients with stability.The number of patients with the initial maximum aortic diameter greater than50 mm in the progressive group and the stable group was compared,of which the difference was statistically significant(p=0.008).A total of 12 patients with initial maximum hematoma thickness greater than 10 mm,including 9 patients with progressive hematoma and 3 patients with stable hematoma.The number of patients with initial maximum hematoma thickness greater than 10 mm in the progressive group and the stable group was also compared,of which the difference was statistically significant too(p=0.004).Conclusion :(1)it is feasible for patients with type A aortic intramural hematoma to receive emergency surgical treatment or medical treatment under close observation and timely surgical treatment.(2)compared with emergency surgery,timely surgical treatment for patients with progression after drug treatment will not increase the surgical mortality and the scope of surgical repair.(3)the disease progression is likely to occur when the initial maximum aorta diameter is >50mm or the initial maximum hematoma thickness is >10mm,so emergency surgical treatment is recommended. |
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