主动脉夹层动脉瘤的手术治疗体会  

Surgical treatment for dissection of aorta aneurysm

作　　者：王进[1] 肖锋[1] 肖建涛[1] 李岩[1] 信维强[1] 杨阳[1] 宋波[1] 李西慧[1] 张明礼[1] 

机构地区：[1]北京大学第一医院心脏血管外科,北京100034

出　　处：《中国现代医学杂志》2007年第1期103-105,108,共4页China Journal of Modern Medicine

摘　　要：目的通过总结该院心脏外科手术治疗主动脉夹层动脉瘤病例的临床资料,探讨手术适应证的把握,改进相关体外循环技术和脑保护技术。方法2000年4月￣2006年5月,共行主动脉夹层动脉瘤手术31例,StanfordA型24例,B型7例。其中急诊手术9例,择期或限期手术22例。18例A型夹层动脉瘤在深低温、停循环(或低流量)的条件下进行手术,其余6例是在浅低温体外循环下进行,其间进行经右锁骨下动脉插管的选择性脑灌注和大剂量糖皮质激素脑保护。B型夹层动脉瘤全部在全身麻醉下进行手术操作。结果A型夹层动脉瘤的手术死亡率16.7%;2000￣2003年手术死亡率为23.5%(4/17),2004年￣2006年5月手术死亡率为14.3%(2/14)(P<0.05);急诊手术死亡率为44.4%(4/9),非急诊手术死亡率为9.1%(2/22)(P<0.01)。结论StanfordA型夹层动脉瘤的手术死亡率远低于非手术治疗的死亡率;近3年深低温停循环结合右锁骨下动脉灌注和大剂量糖皮质激素脑保护、降主动脉记忆合金支架等新技术、新方法的应用,大幅度降低死亡率和围手术期并发症发生率;急诊手术本身也是影响手术死亡的一个危险因素。[Objective] To summarize and discuss the surgical cases of aortic aneurysm, the operation indications, and the advances in relevant extra-corporeal circulation and cerebral protection techniques. [Methods] From April 2000 to May 2006, 31 cases were operated, including 24 cases of Stanford type A, 7 cases of type B, 9 cases emergency surgery. 18 cases of type A dissection aneurysm patients were performed with deep hypothermic circulation arrest （DHCA）. Selective cerebral protection （SCP） and high-dose glucocorticosteroid were also applied.[Resuits] Surgical mortality of type A dissection was 16.7%. From 2004 to May 2006, the operative mortality dropped significantly from 23.5% to 14.3% （P 〈0.05）, compared with former 3 years outcomes. Emergent surgical mortality and non-emergent surgical mortality were 44.4% and 9.1% respectively （P 〈0.01）. [Conclusion] Surgical mortality of type A was quite acceptable and rather lower than non-surgical mortality. New techniques and methods, such as DHCA with SCP and high-dose glucocorticosteroid in cerebral protection, were of importance for the successful surgery results. Emergent operation was also a risk factor affecting the surgical mortality.

关 键 词：主动脉瘤 动脉瘤 夹层 血管外科手术 

分 类 号：R543.16[医药卫生—心血管疾病]