98例主动脉夹层的外科治疗  

Surgical Management for 98 Patients with Aortic Dissection

作　　者：邓宏平[1] 王志维[1] 程邦昌[1] 夏军[1] 张遵严[1] 陈雪芬[1] 丁良儒[1] 李罗成[1] 胡小平[1] 吴红兵[1] 

机构地区：[1]武汉大学人民医院心血管外科,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2010年第5期686-690,共5页Medical Journal of Wuhan University

摘　　要：目的:总结98例主动脉夹层外科治疗的临床经验。方法:全麻深低温停循环下手术治疗DebekayⅠ型48例、Ⅱ型5例、Ⅲ型45例。其中男性52例、女性46例,年龄26-65岁,平均(52.2±5.8)岁。Ⅰ型行升主动脉、全弓置换加支架"象鼻"手术(近端单纯升主动脉置换26例、Bentall手术13例、Wheat手术7例、David手术2例),Ⅱ型行Bentall手术4例、Wheat手术1例,Ⅲ型均行支架"象鼻"手术。结果:住院死亡5例(5.10%),1例术中死于大出血,4例术后死于多脏器功能衰竭。术后偏瘫5例(5.10%)、血管吻合口出血二次开胸止血7例、急性肾功能衰竭行床边透析4例,均痊愈。12例出现短暂性神经功能障碍、8例伤口感染,处理后恢复。声音嘶哑4例。88例出院前复查64排CT见升主动脉及主动脉弓部人工血管无扭曲、血流通畅,无假性动脉瘤形成,5例慢性Ⅰ型夹层病人降主动脉真腔较术前明显扩大。82例随访6-42个月,无死亡及需要再次手术者。结论:手术治疗主动脉夹层安全、有效。Objective：To review the experience of surgical treatment of 98patients with aortic dissec-tion.Methods：Forty-eight consecutive patients with Debekay typeⅠaortic dissection underwent ascending aorta and total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta,including graft replacement of ascending aorta in 26 cases,Bentall procedure in 13 cases,Wheat procedure in 7 cases,and David procedure in 7 cases.The patients with Debekay type Ⅱ aortic dissection underwent Bentall procedure in 4 cases,and Wheat procedure in 1 case.Forty-five patients with Debekay Ⅲ type aortic dissection underwent transaortic stented graft implantation into the descending aorta.Results：The in-hospital mortality was 5.10%,and 82 patients（83.7%）were followed up for 6-42 months,during which no case of death and reoperation was found.Conclusion：Surgical management for aortic dissection has an excellent effect.The described bilateral cerebral perfusion technique is easy,safe,and effective.

关 键 词：人工血管 主动脉夹层 体外循环 

分 类 号：R654.3[医药卫生—外科学]