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B型主动脉夹层的手术治疗和腔内治疗

Author
James H Black, III, MD
Section Editors
Joseph L Mills, Sr, MD
John F Eidt, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS
Translators
熊利华, 主任医师，教授

引言

据估计，急性主动脉夹层的发病率为5-30例/百万人[1]。B型主动脉夹层起自胸降主动脉和/或腹主动脉(左锁骨下动脉开口以远)(图 1)。非复杂性B型主动脉夹层的初始治疗方法仍然为内科治疗[2,3]，这源自20世纪60年代的早期经验，其提示内科治疗的结局比手术治疗更好[4,5]。非复杂性B型主动脉夹层的初始内科治疗旨在稳定患者的血流动力学状况，从而尽量减小夹层的范围、降低内膜瓣的活动度，以及降低破裂风险。接受了内科治疗的非复杂性B型主动脉夹层患者的死亡率较低，为1%-2%[6]。如果不接受治疗，75%的患者会在初始2周内因主动脉夹层而死亡[7]。 (参见“主动脉夹层的治疗”，关于‘紧急治疗’一节)

对于出现并发症的患者，需要进行干预(腔内治疗、手术治疗)。虽然进行了适当的内科治疗和手术治疗，B型主动脉夹层的早期死亡率仍然较高，达10%-15%，在总体死亡率中占比较大[8-11]。由于主动脉破裂并不常见(在所有B型主动脉夹层中的发生率不到5%)，故大多数早期不良结局都与灌注不良有关[6,12]。

本文将总结B型主动脉夹层的腔内治疗和手术治疗。B型主动脉夹层的分类、临床特征、诊断和内科治疗见其他专题。A型主动脉夹层的治疗也见其他专题。 (参见“主动脉夹层的临床表现及诊断”和“主动脉夹层的治疗”)

病因和病理生理学

主动脉夹层可大致分为散发性(即由退行性病变引起，包括动脉粥样硬化、炎症/感染)、遗传相关综合征性(例如，马方综合征、血管埃勒斯-当洛斯综合征、Loeys-Dietz综合征及Turner综合征)或非综合征性(例如，家族性、与二叶式主动脉瓣畸形相关性)。 (参见“胸主动脉瘤的流行病学、危险因素、发病机制及自然病程”，关于‘危险因素’一节)

主动脉夹层发生和进展的病理生理学、导致的症状和体征，以及B型主动脉夹层的并发症见其他专题。 (参见“主动脉夹层的临床表现及诊断”)

                        

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Literature review current through: 2017-06 . | This topic last updated: 2016-11-01.
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