福島医学雑誌 57 巻 1 号　2007

〔原　　著〕

急性A型大動脈解離症例に対する診断と治療の現況

佐藤　洋一，佐戸川弘之，高瀬　信弥，三澤　幸辰
若松　大樹，佐藤　善之，横山　　斉

福島県立医科大学医学部心臓血管外科学講座

（受付　2007年1月17日）

Diagnosis and Therapy for Acute Type A Aortic Dissection: Single Center Experience

YOICHI SATO, HIRONO SATOKAWA, SHINYA TAKASE, YUKITOKI MISAWA,
HIROKI WAKAMATSU, YOSHIYUKI SATO and HITOSHI YOKOYAMA

Department of Cardiovascular Surgery, Fukushima Medical University School of Medicine, Fukushima

要旨: 急性A型大動脈解離症79例についての診断および治療の現況について検討した。ER搬送前の診断は，発症時症状の多様性とその変化により難渋することも多く，診断が得られず急変して緊急搬送する症例も認めた。解離疾患の存在を常に念頭におき診察を行ない，臨床経過から少しでも疑ったら造影CTで確診を得ることが重要と考えられた。偽腔開存型および血栓閉塞型に対する治療方針は，その早期および遠隔成績から妥当と考えられ，最大径50 mm以上の血栓閉塞型は緊急手術を行なうべきと考えられた。手術戦略に関しては，成績は良好であり術前状態が安定していれば全例救命可能であった。遠隔期成績にも問題はなく，当教室の戦略の妥当性が示唆された。

索引用語: 大動脈解離，急性A型解離，造影CT，早期血栓閉塞型，遠隔期成績

Abstract: The current status of diagnosis and treatment of acute type A aortic dissection were investigated among a total of 79 patients. Diagnosis prior to transportation of patients to the ER emergency room was often difficult due to differences and changes in symptoms at the time of onset, and some patients were transported to the ER without a diagnosis due to sudden aggravation. It is therefore important to always consider the possibility of aortic dissection during examination, and to confirm diagnosis on contrast CT if dissection is at all suspected during the clinical course. Appropriate courses of treatment for dissections with open and thrombosed false lumen at the ascending aorta were determined based on their early and midterm outcomes in our department, and emergency surgery was indicated for cases of thrombosed type with a maximum ascending aorta diameter of 50 mm. Surgical outcomes were favorable, and survival could be achieved in all patients with a stable preoperative status. Since no problems were reported with regard to midterm outcomes, these results indicate the validity of our surgical strategy.

Key words: Aortic dissection, Acute type A aortic dissection, contrast CT, early thrombosed type