115例胸主动脉夹层瘤的治疗分析  

Surgical treatment of thoracic aortic dissecting aneurysm: A report of 115 cases

作　　者：景华[1] 李德闽[1] 董国华[1] 李忠东[1] 罗立国[1] 胡小南[1] 许飚[1] 申翼[1] 顾卫东[1] 钱建军[1] 张利东[1] 周志强[1] 张晓华[1] 程晓峰[1] 

机构地区：[1]南京军区南京总医院心胸外科,江苏南京210002

出　　处：《医学研究生学报》2008年第1期37-39,42,共4页Journal of Medical Postgraduates

基　　金：军区医药卫生"十一五"科研基金资助项目(批准号:06Z017)

摘　　要：目的:总结分析胸主动脉夹层瘤的手术治疗经验。方法:选取1995年12月至2006年12月的115例胸部主动脉瘤患者资料进行回顾性分析,38例DeBakey I型主动脉夹层瘤患者中,行升主动脉加全弓部血管置换术30例(其中行全胸段主动脉血管置换加Wheat手术2例、主动脉带瓣管道置换25例、主动脉瓣成形术3例)、术中降主动脉植入覆膜支架6例、升主动脉加半弓血管置换8例;59例Ⅲ型主动脉夹层瘤患者中36例经左后外侧胸部切口、左心转流下或自体血液转流下行降主动脉瘤切除、人造血管置换术;23例用介入的方法经股动脉植入降主动脉覆膜支架行腔内隔绝治疗。结果:115例患者中5例围手术期死亡,其他患者均痊愈出院,随访3个月至9年10个月,2例因不同原因于手术后远期死亡,余均健康存活。结论:对于胸主动脉夹层瘤应采用积极的外科治疗方法,全弓血管置换应用双侧颈动脉灌注对脑的保护效果确切,术中应用改良象鼻手术可以简化手术操作,Ⅲ型夹层瘤应用覆膜支架行腔内隔绝治疗是安全有效的方法。Objective： The present study aims to summarize the clinical experience in the surgical treatment of thoracic aortic dissecting aneurysm. Methods： We retrospectively analyzed the clinical data of 115 cases of thoracic aortic dissecting aneurysm treated by surgery from December 1995 to December 2006. Thirty-eight of them were DeBakey type Ⅰ aortic dissection, 18 type Ⅱ , and 59 type Ⅲ. Of the 38 DeBakey type Ⅰ patients, 30 underwent ascending aorta with total aortic arch replacement （ 2 cases of total thoracic aortic artificial vessel replacement, 25 Wheat procedure and 3 aortic valvuloplasty） and the other 8 received ascending aorta with semi-aortic arch replacement. Of the 59 DeBakey type Ⅲ patients, 36 underwent descending aortic aneurysm resection with artificial vessel replacement via left posterolateral thoracic incision by left heart bypass or aorta to artery bypass （using Cott tubes） , while the other 23 received endovascular stent-graft exclusion in descending aorta via the femoral artery. Results： All the patients were successfully treated except 5 that died during the perioperative period. The survivors were followed up for 3 - 118 months, among whom 2 died long-term death after the operation and the others were living healthy. Conclusion： Surgical treatment improves the clinical outcome of thoracic aortic dissecting aneurysm. Bilateral perfusion via the carotid artery in aortic arch replacement has a definite cerebral protective effect. Surgical procedures can be simplified by using the modified elephant trunk technique. Endovascular stent-graft exclusion is safe and effective in the treatment of DeBakey type Ⅲ aortic dissection.

关 键 词：胸主动脉夹层瘤 外科 脑保护 脊髓保护 覆膜支架 腔内隔绝 

分 类 号：R732.21[医药卫生—肿瘤]