升主动脉扩张包裹术的临床治疗经验探讨  

Clinical experience with wrapping of the dilated ascending aorta

作　　者：王文杰 陶杰[1] 白向锋[1] 梅松[1] 雷雨 李斌[1] Wang Wenjie;Tao Jie;Bai Xiangfeng(Department of cardiovascular surgery,the first affiliated hospital of Kunming Medical University kunming,Yunnan,650032,China)

机构地区：[1]昆明医科大学第一附属医院心脏大血管外科

出　　处：《云南医药》2019年第6期486-489,共4页Medicine and Pharmacy of Yunnan

摘　　要：目的本研究目的是对升主动脉扩张的患者行升主动脉包裹术后的近期随访。方法自2013年1月-2017年12月我院37例升主动脉扩张患者接受升主动脉包裹术(平均年龄65.5岁范围30~75岁,其中男性22人,女性15人)。升主动脉包裹所用材料为30~34mm直的涤纶血管,均未切开升主动脉壁。其中合并其他心脏手术的有36例(97%),合并主动脉瓣手术的有32例(86%)。结果所有病例无因为住院期间并发症死亡,其中2例病人二次开胸止血,1例病人术后第5d出现脑梗塞,有3例病人出现呼吸功能不全延长脱离呼吸机时间。随访时间平均数为(18.5±8.5)月(范围为12~36月)。无病例出现升主动脉再扩张和包裹血管的移位。有3例患者随访期间死亡,1例因肾功能衰竭死亡,1例因呼吸功能衰竭死亡,1例患者瓣膜置换术后抗凝过度,消化道大出血死亡。结论研究表明:升主动脉包裹术近期结果良好,可以作为中度升主动脉扩张治疗方法。Objective External wrapping is a surgical technique performed in patients with a dilate dascending aorta. The aim of this study is to present the mid-term results of wrapping of the dilate dascending aorta.Methods From January 2013 to December 2017 37 cases of aortic root aneurysm patients who underwent aortic root wrapping in our hospital(median65.5 range:30-75,22 males,15 females) with a dilated ascending aorta were operated on at our hospital using a wrapping technique. The aortas were wrapped with 30-34 mm straight Dacron vascular prostheses.The aortic wall was not excised in any of the patients. Wrapping was performed concomitant to other cardiac surgery procedures in36 patients(97%), which involved surgery on the aortic valve in32 patients(86%).Results None of the patients died or had aortic complications during the hospital stay. A rethoracotomy had to be performed due to excessive postoperative bleeding in two patients. One patient was diagnosed with a cerebral infarction on the 5 th postoperative day, while other two had respiratory failure requiring prolonged intubation. The mean follow-up time was 18.5±8.5 months(median: 18 months, range: 12-36 months). No redilatation of the ascending aorta or dislocation of the wrap was noticed in any of the patients.Three were dead in the follow-up period, One died of renal failure and one died of respiratory failure, 1 patient died of excessive anticoagulation and massive hemorrhage of digestive tract.Conclusion According to our study, external wrapping of the ascending aorta has good short-term results and may be regarded as a safe surgical option for patients with a moderately dilated ascending aorta.

关 键 词：动脉瘤 升主动脉 包裹术 

分 类 号：R732.21[医药卫生—肿瘤]