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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2015, Vol. 09 ›› Issue (01) : 18 -21. doi: 10.3877/cma.j.issn.1674-0793.2015.01.005

所属专题： 文献；

论著

主动脉夹层并发下肢灌注不良误诊为下肢动脉栓塞特点分析
吴梦涛1, 陆清声1, 赵志青1, 包俊敏1, 景在平1,†()   
  1. 1. 200433　上海,第二军医大学第一附属医院血管外科全军血管外科研究所
  • 收稿日期:2014-12-10 出版日期:2015-02-01
  • 通信作者: 景在平
  • 基金资助:
    国家自然科学基金项目(81170291;81330034)

Characteristics of lower limb malperfusion in aortic dissection and the reasons for misdiagnosis as lower extremity arterial thromboembolism

Mengtao Wu1, Qingsheng Lu1, Zhiqing Zhao1, Junmin Bao1, Zaiping Jing1,†()   

  1. 1. Department of Vascular Surgery, the First Affiliated Hospital, the Second Military Medical University, Institute of Vascular Surgery of PLA, Shanghai 200433, China
  • Received:2014-12-10 Published:2015-02-01
  • Corresponding author: Zaiping Jing
  • About author:
    Corresponding author:Jing Zaiping, Email:
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吴梦涛, 陆清声, 赵志青, 包俊敏, 景在平. 主动脉夹层并发下肢灌注不良误诊为下肢动脉栓塞特点分析[J]. 中华普通外科学文献(电子版), 2015, 09(01): 18-21.

Mengtao Wu, Qingsheng Lu, Zhiqing Zhao, Junmin Bao, Zaiping Jing. Characteristics of lower limb malperfusion in aortic dissection and the reasons for misdiagnosis as lower extremity arterial thromboembolism[J]. Chinese Archives of General Surgery(Electronic Edition), 2015, 09(01): 18-21.

目的

探讨急性B型主动脉夹层(TBAD)并发下肢灌注不良(LLM)的临床特点,分析其被误诊为急性下肢动脉血栓栓塞的原因。

方法

回顾性分析本院自2011年12月至2014年11月收治的23例TBAD并发LLM被误诊为下肢动脉血栓栓塞病例,通过病史、主诉特点及诊治方法分析其临床特点。

结果

23例患者均经多层螺旋CT血管成像(CTA)确诊为TBAD并发LLM,均成功行主动脉夹层腔内修复术治疗。其中1例于麻醉前发生主动脉夹层破裂,术后4 d因多器官功能衰竭死亡。其余22例均治愈出院。

结论

正确认识TBAD并发LLM的疾病特点,认真全面分析患者临床信息,系统掌握血管病学知识是防止误诊误治的关键。

关键词: 主动脉, 夹层, 下肢, 灌注不良, 血栓栓塞
Objective

To investigate the characteristics of lower limb malperfusion (LLM) in type B aortic dissection (TBAD) and to analyze the reasons for misdiagnosis as acute lower extremity arterial thrombosis embolism.

Methods

A retrospective study was carried out of twenty-three patients with LLM in TBAD in our hospital from December 2011 to November 2014. The clinical characteristics were analyzed from history, chief complaint, diagnosis and treatment for the patients.

Results

All the 23 patients were diagnosed by CTA as LLM in TBAD. All patients were successfully treated with thoracic endovascular repair. Due to the sudden rupture of aortic dissection before anesthesia, 1 patient died of multiple organ failure on postoperative day 4. The remaining 22 patients were cured.

Conclusion

A correct understanding of the characteristics of LLM in TBAD, the careful and comprehensive analysis of clinical information, and the comprehensive grasp of vascular disease knowledge is the key to prevent misdiagnosis and mistreatment.

Key words: Aortic, Dissection, Lower extremity, Malperfusion, Thromboembolism
表1 23例患者全身及下肢主诉特点
变量 患病数[例(%)]
全身症状 ?
? 突发胸背撕裂痛 14(60.9)
? 突发胸闷、心慌 2(8.7)
? 突发头晕 2(8.7)
? 突发声嘶 2(8.7)
? 突发晕厥 3(13.0)
下肢发病部位 ?
? 左 14(60.9)
? 右 6(26.1)
? 双 3(13.0)
下肢症状 ?
? 间歇性跛行 2 (8.7)
? 股动脉搏动减弱或消失 21(91.3)
? 疼痛 18(78.3)
? 麻木 18(78.3)
? 肢体苍白 21(91.3)
? 运动障碍 5(21.7)
图1 复杂性Standford B型主动脉夹层并下肢灌注不良术前和术后CTA
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