DeBakey Ⅲ型夹层动脉瘤的治疗  

Treatment of Dissecting Aneurysm of DeBakey Type Ⅲ

作　　者：王京生[1] 孙衍庆[1] 刘传绶[1] 解基严[1] 王新生[1] 陈生龙[1] 

机构地区：[1]北京医科大学人民医院

出　　处：《中国循环杂志》1998年第3期161-163,共3页Chinese Circulation Journal

摘　　要：目的：分析与总结我院收治的ＤｅＢａｋｅｙⅢ型夹层动脉瘤患者３５例的治疗经验与效果。方法：本组男性３２例，女性３例，男女比例为１０∶１，年龄２１～６４岁，平均５２．０±３．２岁。全部患者均经Ｘ线胸片，数子减影血管造影术，计算机断层摄影术，磁共振成像检查证实诊断，动脉瘤的直径４．６～９．０ｃｍ，平均５．１±２．２ｃｍ。全组患者中２１例进行了手术治疗（手术组），其中１７例行人造血管部分降主动脉替换术，２例行升主动脉及腹主动脉转流手术，２例行主动脉折叠手术。１４例未行手术（非手术组）。结果：手术组死亡３例（术中出血１例，住院死亡２例）。非手术组８例在住院期间动脉瘤破裂（６例死亡，２例包裹后出院，半年后因动脉瘤再次破裂死亡）；２例随访３年存活；１例失访；３例自动出院。结论：目前对ＤｅＢａｋｅｙⅢ型夹层动脉瘤的治疗尚存在不同意见，本组患者结果表明手术治疗优于非手术治疗（Ｐ＜０．０５）。Objective:To study and review a series of 35 cases of DeBakey type Ⅲ (Stanford Type B) dissecting aneurysm from Sep.1990 to Sep.1995 in this hospital. Methods:We studied and analyzed clinical status of all 35 patients.Of them 32 males and 3 females,aged from 21—64 (mean 52.0±3.2) years.All the patients were diagnosed by chest X ray,CT,MRI and DSA.The diameter of dissecting aneurysm ranged 4.6—9.0 (mean 5.1±2.2) cm.Twenty one cases were treated surgically and 14 cases nonsurgically.For the surgically treated group,17 cases underwent standard graft replacement of proximal descending aorta,2 underwent the plication of aneurysm,2 were operated by pass from ascending to abdominal aorta. Results:In the surgically treated group,3 cases died (1 of massive hemorrhage during operation,1 of postoperative myocardial infarct,the other of rupture of abdominal aneurysm).In the nonsurgically treated group,8 cases had aneurysm ruptured during hospitalization (6 died in hospital and 2 encapsulated cases died of re rupture 6 months later);2 survived for 3 year follow up;1 was missed from the follow up;the other 3 were discharged after refusal of treatment. Conclusion:Up to now it has been controversy in the treatment of DeBakey type Ⅲ dissecting aneurysm,but in this group the results of surgical intervention are better than those of medical treatment( p <0.05).

关 键 词：胸部 主动脉瘤 夹层动脉瘤 外科手术 

分 类 号：R543.16[医药卫生—心血管疾病]