主动脉夹层瘤诊断和治疗方法的选择  

The Choice of Diagnoses and Treatments for Aortic Dissection

作　　者：尤庆生[1] 严煜[1] 刘琨[1] 陈荫椿[1] 

机构地区：[1]南通大学附属医院心胸外科,江苏南通226001

出　　处：《中国临床医学》2006年第3期359-361,共3页Chinese Journal of Clinical Medicine

摘　　要：目的：通过本院18例主动脉夹层瘤的分析,初步探讨主动脉夹层瘤诊断和治疗方法的选择。方法：本组18例,男性15例,女性3例,年龄27～77岁,平均52岁；术前检查,增强CT 18例,心脏彩色多普勒18例．磁共振3例,DSA 6例；DEBAKEY分类：Ⅰ型8例,Ⅱ型2例,Ⅲ型8例；3例合并有主动脉瓣二叶式畸形。体外循环手术12例,其中Bentall术3例,Wheat术2例,全弓置换3例,半弓置换5例。6例采用覆膜支架植入术。结果：本组体外循环时间111～420 min,平均193 min,阻断升主动脉时间53～154 min,平均82 min,深低温停循环时间5～60 min,平均21.33 min。术后呼吸机应用时间12h～96h,平均20h。1例术中死亡,其余病例术后均无肾功能衰竭、呼吸衰竭、心功能衰竭和消化道出血；无脑栓塞,无截瘫,无插管侧股动脉栓塞和肢体坏死。门诊随访所有病人均生存良好。结论：对疑似病例可以通过先做螺旋CT增强造影,然后心脏彩色多普勒,然后MRI,最后DSA的顺序来明确诊断。对于DEBAKEYⅠ型和Ⅱ型主张急诊手术；可根据主动脉根部情况决定是否做Bentall还是Wheat,根据破口的位置和范围决定是否做全弓或半弓置换；DEBAKEYⅢ型的主张限期手术,行降主动脉人工血管置换或主动脉覆膜支架植入术。Objective：To discuss the selection of diagnose and treatment method for aortic dissection by analyzing 18 cases of aortic dissection in our hospital. Methods： There were 15 men and 3 women whose mean age was 52 years （range 27-77 years） ; Before operation by CT was done for 18 cases , cardia supersonic doppler for 18 cases, MRI for 3 cases, DSA for 6 cases. DeBakey typeⅠ8 cases, typeⅡ2 cases, typeⅢ8 cases. 3 cases go with bicuspid aortic valves. 12 cases were operated by cardiopulmonary bypass among these cases, 3 cases were Bentall, 2 cases were Wheat, 3 cases were total arch replacement and 5 cases were hemiarch replacement. And another 6 cases were grafted with endovascular stent. Results： The mean time of cardiopulmonary bypass was 193 minutes （range 111-420minutes）; the mean time of aorta occluded was 82 minutes （range 53- 154minutes）, The mean time of deep hypothermic circulatory arrest was 21.33minutes （range 5-60minutes）, the mean time of respiratory support was 20 hr（range 1296 hr）. 1 case died during operation ; Others were good without renal failure, respiratory failure, heart failure and gastrorrhagia, cerebral embolism and paraplegia, arterial embolism and necrosis of lower limbs. All patients were good by following up in outpatient department. Condusion： Aortic dissection may be diagnosed by CT first, and then cardia supersonic Doppler, and then MRI,and last DSA, The cases of DeBake type Ⅰ and type Ⅱshould be operated emergently. We may choose Bentall or Wheat procedure depend on condition of aortic root and the aortic valve, and we may choose total arch replacement or hemiarch replacement depend on the distal extent of aortic involvement. DeBake typeⅢ my be operated in time limited, we may choose descending aortic replacement or endovascular stent grafting.

关 键 词：主动脉夹层瘤 诊断 治疗 

分 类 号：R543.16[医药卫生—心血管疾病]