主动脉瘤40例治疗体会  

Surgical treatment and endovascular graft exclusion for aortic aneurysms

作　　者：姚建民[1] 贾清仁[1] 卢宁[1] 肖志斌[1] 赵向东[1] 王明岩[1] 陆龙[1] 冉宁[1] 

机构地区：[1]北京军区总医院心血管病中心外科,100700

出　　处：《临床外科杂志》2007年第2期117-119,共3页Journal of Clinical Surgery

摘　　要：目的介绍外科与腔内隔绝术治疗主动脉瘤的体会。方法手术与腔内隔绝术治疗主动脉瘤40例，手术治疗30例，Bentall术9例，Bentall＋部分弓置换3例，主动脉瘤切除人工血管置换6例，主动脉瘤切除补片修补4例，升主动脉＋部分弓置换、主动脉瓣二尖瓣置换＋升主动脉折叠缝合术各2例，主动脉瓣置换＋升主动脉置换、主动脉瓣置换升主动脉折叠缝合术、主动脉瘤切除直接缝合、主动脉瘤切除人工血管置换＋左全肺切除术各1例。腔内隔绝术治疗假性胸降主动脉瘤1例、假性腹主动脉瘤1例、夹层主动脉瘤ⅢA型1例、ⅢB型7例，经股动脉切口植入32～38mm覆膜支架。结果手术后因低心排出量综合征和出血各死亡1例，死亡率6．7％，无截瘫、偏瘫和感染。覆膜支架腔内隔绝术后1～2周内低热8例，无大出血、内漏和死亡。生存38例，随访1个月～5年，无死亡和远期并发症。结论升弓部主动脉瘤的手术治疗效果满意，覆膜支架腔内隔绝治疗DeBakeyⅢ型夹层主动脉瘤创伤小、并发症少、恢复快。Objective To explore the surgical treatment and endovascular graft exclusion for aortic aneurysms. Methods Between November 1991 and July 2006,40 patients, aged from 5 - 78 years old, with aortic aneurysms underwent surgical treatment and endovascular graft exclusion procedure. There were 11 cases of Marfan syndrome, 1 case of DeBakey type Ⅰ of aortic dissection, 8 cases of DeBakey type Ⅱ ,1 case of DeBakey type ⅢA,8 cases of DeBakey type ⅢB,4 cases of thoracic pseudoaneurysm,4 cases of abdominal aneurysm, 1 case of ascending aortic aneurysmal dilation with aortic valvu- lar stenosis,2 cases of ascending aortic aneurysmal dilation with aortic valvular stenosis and mitral valvular insufficiency. Nine patients were subjected to Bentall procedures, 3 to Bentall procedures combined with partial aortic arch replacement, 6 to aortic replacements, 4 to aortic patch repairs, 2 to ascending aortic and partial arch replacement, 1 case of ascending aortic and aortic valve replacement, 2 eases of double valvereplacement combined with ascending aortic plieation, 1 case of aortic valve replacement combined with ascending aortic plication, 1 case of direct suture, 1 case of aortic replacement combined with left pneumoectomy, 10 cases of endovascular graft exclusion. Results There were 2 postoperative deaths （6.7 % ） with no infection, paraplegia and paresis in surgical treatment. Eight cases had 1 to 2 weeks of mild fever with no massive haemorrhage,leak and death after endovascular graft exclusion. During a follow - up riod of 1 month to 5 years,38 survivors had no death and long- term complications. Conclusion Surgieal treatment of ascending and arch aortic aneurysms appears to be satisfactory. Endovascular graft exclusion can be a minimally invasive and safer alternative to surgical procedure for DeBakey type Ⅲ of aortic dissection.

关 键 词：主动脉瘤 夹层动脉瘤 血管腔内隔绝术 

分 类 号：R543.1[医药卫生—心血管疾病]