Objective: To explore the diagnosis and treatment of pregnancy-associated acute Stanford type A aortic dissection to improve the maternal and fetal outcomes.
Methods: We analyzed the perioperative data of 5 pregnant women with acute Stanford type A aortic dissection treated between June, 2009 and February, 2017.
Results: The median age of the women was 30 years (range, 22-34 years) with gestational weeks of 23-38 weeks upon diagnosis. All the 5 patients received surgical interventions. Three patients underwent caesarean delivery and hysterectomy, and the fetuses survived after the surgery; 2 patients chose to continue pregnancy following the surgery, among whom one died due to postoperative complications and the other underwent termination of pregnancy. During follow-up, the surviving patients showed no endoleak in the descending aorta stent and the distal dissection remained stable.
Conclusion: The maternal and fetal outcomes of pregnancy-associated acute Stanford type A aortic dissection can be improved by multidisciplinary cooperation and optimization of the surgical approaches according to the time of pregnancy, fetal development and conditions of the aortic lesions.
目的: 探讨妊娠合并急性Stanford A型主动脉夹层的诊治方法，以提高母婴救治成功率。
方法: 回顾性分析2009年6月~2017年2月广东省人民医院5例妊娠期患急性Stanford A型主动脉夹层孕妇围术期资料, 通过对孕周及夹层病变程度、全身影响程度分析手术方式和时机。
结果: 5例患者中位年龄30岁（22~34岁），发病时孕周23~38周；5例均接受手术治疗，3例同期行剖宫产+子宫切除，2例继续妊娠。术后1例死于并发症。剖宫产3例胎儿均存活，继续妊娠者，1例胎儿宫内死亡，1例引产。随访期间，降主动脉支架无内漏，夹层远端无扩大。
结论: 在基于挽救母亲和胎儿生命的前提下，急性Stanford A型主动脉夹层孕妇术前应多学科综合评估，根据妊娠时间、胎儿发育情况、主动脉病变程度决定手术方案。