34例主动脉夹层动脉瘤的外科治疗  

Surgical treatment of aortic dissection aneurysm in 34 cases

作　　者：杨辰垣[1] 刘成硅[1] 肖诗亮[1] 孙宗全[1] 张凯伦[1] 夏家红[1] 周诚[1] 蓝鸿钧[1] 

机构地区：[1]华中科技大学协和医院心外科华中科技大学同济医院心血管病研究所,武汉430022

出　　处：《临床心血管病杂志》2004年第6期346-348,T001,共4页Journal of Clinical Cardiology

摘　　要：目的 :探讨外科治疗主动脉夹层动脉瘤安全有效的术式及方法。方法 :对 34例主动脉夹层动脉瘤患者 ,采用Cabrol手术 10例 ,Bentall手术 8例 ,升主动脉夹层缝闭加主动脉瓣成形术 1例 ,升主动脉腹主动脉搭桥转流手术 8例 ,升主动脉双侧髂总动脉搭桥转流手术 1例 ,降主动脉夹层动脉瘤切除加人造血管替换 1例 ,双侧腋动脉股动脉搭桥转流手术 5例。结果 :32例存活 ,2例围手术期死亡 ,死亡率为 5 .9%。结论 :当冠状动脉开口直接缝合于带瓣管道上有困难而不宜行Bentall手术时 ,采用Cabrol手术有其优点 :采用 1根 8mm直径的Gore Tex管与左、右冠状动脉开口进行连接吻合 ,吻合口没有张力且对合严密 ,避免了冠状动脉开口周围内膜撕脱和吻合口漏血 ;对手术切除夹层动脉瘤有困难、高危险患者 ,采用大动脉转流手术 ,特别是采用不需要开胸和开腹的双侧腋动脉股动脉搭桥转流手术 ,手术创伤小、安全 ,效果好 ,手术适应证宽 ,应用前景广阔。Objective: To review the surgical results and experience of aortic dissecting aneurysm in 34 cases. Method:Thirty-four patients with aortic dissecting aneurysm underwent surgical treatment. The procedure performed included 10 Cabrol's operation. 8 Bentall's procedures, one of closure of dissection with aortic valvular plasty, and 14 of derivation bypassing the dissected aorta. Result: Thirty-two of the 34 patients recovered uneventfully. There was 2 postoperative death with a mortality of 5.9%. Conclusion: The modificaton of Cabrol operation can improve surgical outcome of type Ⅱ aortic dissection aneurysm. A selfblood infusion system bypass is created in case of hemostatic failure between right atrium and aneurismal sac sewn around the Dacron graft. For the type Ⅲ, Through the bypass graft shunt, the pressure and shear stress of blood flow in the false lumen are reduced and thus prevent the further developmentand ruptur of the dissection. Blood flow in the true lumen is partially restored by the reversal flow and the size and extent of the falsa lumen are reduced, and then gradually closed. The good results, less invasive and less complications of great artery bypass sugqest that surgical treatment, especially bilateral axillary artery-femoral artery bypass has wide indication for repair of aortic dissection except aortic insufficiency, especially for the comorbidities such as myocardial infarction and the deteriorate patients who do not suit for sternolaparotomy.

关 键 词：主动脉瘤 动脉瘤 夹层 CABROL手术 双侧腋动脉股动脉转流手术 升主动脉腹主动脉转流手术 

分 类 号：R543.16[医药卫生—心血管疾病]