主动脉夹层的外科治疗  

Surgical treatment of aortic dissection aneurysm

作　　者：啜俊波[1] 李杰[1] 蒋树林[1] 韩振[1] 谢宝栋[1] 

机构地区：[1]哈尔滨医科大学第二临床医学院心外科,黑龙江哈尔滨150081

出　　处：《哈尔滨医科大学学报》2009年第1期100-102,共3页Journal of Harbin Medical University

摘　　要：目的 总结主动脉夹层的外科治疗经验，探讨治疗主动脉夹层安全有效的术式及方法。方法我院2000年1月。2005年8月期间19例接受手术治疗的主动脉夹层患者，其中升主动脉及主动脉弓部替换＋象鼻技术2例，Bentall＋主动脉弓部替换术2例，部分胸主动脉替换术1例，部分胸、腹主动脉替换术3例，David手术1例，弓降部成形1例，Cabrol手术1例，Bentall手术8例，同期行弓部成形1例、二尖瓣成形术1例、冠状动脉搭桥1例。其中4例采用DHCA，其余为浅中低温体外循环。结果手术死亡3例，围术期死亡1例，死亡率21．0％，术后截瘫1例。结论应根据破口及夹层的位置，选择术式和体外循环方法，决定手术范围。术中脑、脊髓保护是治疗主动脉夹层的关键。Objective Reviewing the experience of surgical treatment of aortic dissection to approach an effective and safe method to treat this kind of disease. Methods Nineteen patients with AD accepted surgical treatment from January, 2000 to August, 2005. A graft replacement of ascending aorta and total aortic arch combined with the elephant trunk techniques was performed in 2 patients. Two patients underwent the Bentall procedure and aortic arch graft. Partial thoracic aortic grafting in 1. Partial thoracic and abdominal aortic grafting in 3. David procedure in 1. Aortic arch and descending aorta plasty in 1. Cabrol procedure in 1. Bentall procedure in 8. Concomitant procedures were 1 aortic arch plasty , 1 mitral valve plasty and 1 CABG. Four cases of AD with deep hyperthomic circulation arrest, other cases with the assistance of extrocorporeal circulation. Results There were 3 deaths within operation, 1 paraplegia and 1 death after operation. The overall mortality is 21.0%. Conclusion Procedures chosen must depend on the location of intimal tear. Appropriate brain and spinal cord protection are essential to the treatment of aortic dissection.

关 键 词：主动脉夹层 心脏外科手术 术式选择 

分 类 号：R654.2[医药卫生—外科学]