目的：分析急性Stanford B型主动脉壁间血肿的临床特点及诊治情况。方法2013年6月—2014年8月共收治13例急性Stanford B型主动脉壁间血肿患者，入院初始均采用降压、止痛、镇静为主的药物治疗，通过CT血管造影（ CTA）严密观察，对于病情发展者选择主动脉腔内修复术。结果药物治疗过程中，5例患者血肿均较稳定，经药物治疗后缓解出院；2例10 d后血肿增大而进行腔内修复术；6例伴发有主动脉溃疡而选择腔内手术。5例药物治疗患者随访3～14个月，CTA示壁间血肿均有不同程度吸收，未再次出现胸背部疼痛症状。8例腔内治疗者随访6个月，血肿大部分已吸收，未发生内漏、支架移位等并发症。结论对急性Stanford B型主动脉壁间血肿可在CTA严密观察下，首先进行降压、止痛、镇静为主的药物治疗，若血肿增大或伴发主动脉溃疡等情况，则应及时行腔内修复术。%Objective To analyze the clinical characteristics , diagnosis and treatment experience of acute B type Stanford aortic intramural hematoma .Methods From June 2013 to August 2014 , 13 patients with acute B Stanford type aortic intramural hematoma were enrolled , the initial admission are treated with lower blood pressure , releasing pain and given seda-tion treatment, CT angiography (CTA) were performed to observe the disease progression , and patients with disease progres-sion were treated with aortic endovascular repair .Results In the course of drug treatment , 5 patients were more stable , after drug treatment, they were discharged from hospital , and 2 patients the intramural hematoma enlarged after 10 days, and they were treated with endovascular repair , 6 cases with aortic ulcer were selected intraluminal surgery .5 patients with drug treat-ment were followed up for 3-14 months, the CTA showed that the intramural hematoma was absorbed in different degree , and there was no chest and back pain occurred again .8 patients were followed up for 6 months, the majority of the hematoma was absorbed, and there were no complications such as peri-stent leakage and stent displacement .Conclusion For patients with Stanford type B aortic intramural hematoma , under the strict observation by CTA , patients can be treated with medicine first , if hematoma enlargement or comorbid aortic ulcer , endovascular repair should be selected .
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