胸主动脉瘤和急性主动脉夹层的外科治疗  

Surgical treatment of aortic aneurysms and aortic dissections

作　　者：杨康[1] 廖克龙[1] 王明荣[1] 曾会昌[1] 张伟[1] 熊刚[1] 王海东[1] 李军[1] 谭文峰[1] 刘铭[1] 吴蔚[1] 唐令凤[1] 张玉霞[1] 

机构地区：[1]第三军医大学西南医院胸心外科,重庆400038

出　　处：《第三军医大学学报》2005年第24期2428-2430,共3页Journal of Third Military Medical University

摘　　要：目的总结升主动脉瘤和急性主动脉夹层外科治疗经验。方法2001年2月至2005年10月31例胸主动脉瘤和急性主动脉夹层患者接受了外科手术。男性26例,女性5例;年龄14～72岁,平均年龄41.3岁。主动脉根部瘤和升主动脉瘤20例,StanfordA型急性主动脉夹层8例。施行经典Bentall手术21例,其中合并室缺修补1例,二尖瓣成型2例,二尖瓣置换2例;施行改良Bentall手术4例。施行Wheat手术3例。StanfordB型急性主动脉夹层3例均施行破口段降主动脉切除人工血管置换。结果无住院期死亡,所有患者均痊愈出院,住院13～46d,平均16.4d。随访1～63个月[平均(21±18.5)个月]。术后2年猝死1例,死因不明。1例于术后半年发现主动脉肺动脉瘘1例。1例StanfordB型急性夹层患者术后半年复查发现人造血管远端吻合口内膜出现破口,经腔内覆膜支架隔绝术治愈。结论胸主动脉瘤和急性主动脉夹层的外科治疗能够安全进行。快速准确的诊断、个体化的外科策略和手术方法、精确的手术技术是手术成功的关键。Objective To summarize the experience of surgical treatment of ascending aortic aneurysms and aortic dissections. Methods From February 2001 to October 2005, 31 patients including 26 male, 5 female, aged 41.3 years old （range 14 -72） received surgical management. Twenty cases were diagnosed as ascending aortic aneurysm and aortic root aneurysm, 8 as Standford A dissection, 3 as Stanford B dissection. Twenty-one patients underwent classic Bentall procedure in which VSD repair was carried out in 1 case, mitral valvoplasty in 2 and mitral valve replacement in 2; Four patients underwent modified Bentall procedure （coronary button technique） ; Three patients underwent Wheat procedure; The remaining 3 patients with Stanford B dissection underwent graft replacement of descending aorta. Results There was no death during hospital stay that lasted 13 -46 d with an average of 16.4 d after operation. The mean clinical follow-up was （21 ± 18.5） months （range 1 -63 months）. One patient died without describable cause two years later. One patient had ascending aorta-pulmonary artery fistula at color Doppler examination half a year later. One patient was detected rupture of distal anastomoses half a year after operation and underwent stent-graft, SG. Conclusion The surgical treatment of aortic aneurysms and aortic dissections could be carried out safely based on the accurate diagnosis, specific surgical strategy and fine techniaue.

关 键 词：主动脉瘤 主动脉夹层 外科治疗 

分 类 号：R654.3[医药卫生—外科学] R655[医药卫生—临床医学]