主动脉根部替换术231例临床分析  

Aortic root replacement of 231 cases

作　　者：孙立忠[1] 常谦[1] 郑军 吴清玉 朱晓东 朱俊明 孙晓刚 刘永民 冯钧 

机构地区：[1]阜外心血管病医院心脏外科

出　　处：《中华医学杂志》2000年第10期729-731,共3页National Medical Journal of China

摘　　要：目的　探讨主动脉根部替换术的手术适应证 ,总结手术技术和经验。方法　自 1994年1月至 1999年 8月 ,我院共完成 2 31例主动脉根部替换术 ,其中急诊手术 13例。男 189例 ,女 42例。年龄 14～ 6 9岁。瘤体直径 5～ 11cm。单纯主动脉根部瘤 145例 ,DeBekeyⅠ型主动脉夹层 6 5例 ,DeBekeyⅡ型主动脉夹层 2 1例。手术以复合带瓣人工血管组件替换主动脉根部 2 2 9例 ,行保留主动脉瓣的主动脉根部替换术 2例。结果　围术期死亡 7例 ,死亡率为 3.0 3%。早期并发症包括 :二次开胸止血 6例 ,心包积液 9例 ,脑栓塞、胸腔积液和气胸各 2例 ,均治愈。随诊 175例 (78.12 % ) ,平均随诊时间 15 .7个月± 13.1个月 (2周～ 6 5个月 )。随诊期 1例死于术后 3个月双下肢动脉栓塞、肾功能衰竭。 3例术后因抗凝意外死亡。与术前比较 ,术后平均左室舒张末径由术前的 6 8.1mm± 9.4mm(5 4～ 112mm)恢复为 5 4.8mm± 8.2mm(38～ 88mm) ,两者间有显著性差异 (P <0 .0 0 1)。结论　对于非夹层的主动脉瘤和慢性主动脉夹层 ,如果动脉瘤直径超过 5cm ,就应该进行手术治疗。主动脉夹层自然病程险恶 ,一旦确诊 ,在全身状况允许的条件下应尽早手术。Objective To discuss the operative indications, methods, and surgical techniques of aortic root replacement for aortic not aneurysm. Methods Between January 1994 and August 1999, 231 consecutive patients underwent aortic root replacement in our institution, and 13/231 were treated on an emergency basis. They were 189 men and 42 women, ranging in age from 14 to 69 years. The diameter of the aneurysm varied from 4.5 to 11.0 cm. Among this group, 145 had isolated aortic root aneurysms, 65 suffered from DeBakey type Ⅰ aortic dissection, and the remaining 21 were diagnosed as DeBakey type Ⅱ aortic dissection. Aortic valve regurgitation was involved in all patients. Aortic root replacement was performed with composite valved graft in 229 patients, and 2 patients reserved the aortic valve. Results Hospital mortality was 3.03% (7 patients). The early complications included re exploration for bleeding in 6 patients, pericardial effusion in 9, and cerebral infarction, pleural effusion and pneumothorax each in 2 patients. One hundred and seventy five patients (78.12%) were followed up, with a mean follow up period of 15.7±13.1 months (range, 2 weeks to 65 months). One patient died from lower limb embolism and renal dysfunction at 3 months postoperatively. Three patients died from postoperative anticoagulant accidents. The preoperative and postoperative mean left ventricular end diastolic diameters were significantly different (68.1 mm±9.4 mm, range: 54 to 112; vs 54.8 mm±8.2 mm, range: 38 to 88; P <0.001). Conclusions Aortic aneurysm without dissection or with chronic dissection should be operated if the diameter of the aneurysm is greater than 5 cm. Once a diagnosis of acute aortic root dissecting aneurysm is made, the patient should undergo surgery as soon as possible if the general condition permit.

关 键 词：主动脉瘤 胸 心血管外科 手术方法 

分 类 号：R654.2[医药卫生—外科学]