主动脉窦瘤破裂外科治疗的临床研究

Experience of surgical treatment of ruptured aneurysm of sinus of valsalva

目的 探讨主动脉窦瘤破裂局部病理改变及其合并主动脉瓣关闭不全的手术方法。方法 3 6例主动脉窦瘤破裂 (RASV)合并主动脉瓣关闭不全 (AI) 15例、室间隔缺损 (VSD) 2 6例。补片修补 3 5例 ,其中合并VSD的均以一片法修补 ,合并AI的主动脉瓣置换 (AVR) 6例 ,主动脉瓣成形 4例。手术取材作病理检查 5例。结果 本组 3 6例中手术死亡 2例 ( 5 .6% )。存活的 3 4例病人均经门诊复查或通信随访 0 .3～ 18年 ,其中 2例死亡。病理检查见RASV合并VSD的瘤壁为纤维素样坏死或玻璃样变性。结论 主动脉窦壁纤维素样或玻璃样变性可能是其形成的病理基础。合并主动脉瓣关闭不全时应探查其病变程度 ,酌情一期矫正 ,瓣膜损伤明显时宜行主动脉瓣置换 ,对主动脉瓣环细小的病例 ,可借修补VSD和RASV的补片扩大主动脉瓣环。

Objectives To evaluate the surgical treatment of ruptured aneurysm of sinus of Valsalsa (RASV) and associated aortic valvular insufficiency (AI).Methods Between 1980 and 2003,36 patients with RASV underwent surgery.The surgical procedures included direct suture of RASV in 1 patient,patch repair of RASV in 9 cases,mere one patch repair of RASV and VSD in 26 patients, replacement of aortic valve in 6 patients,valvuloplasty in 4 parients.The resected specimens were examined pathologically.Results There were two operative deaths(5.6%).The follow-up duration ranged from 3-156 months.One patient died of infectious endocarditis,another died of refractory ventricular fibrillation.There was no re-operation due to AI and recurrence or residue shunt of RASV and VSD.Conclusion One patch repair and surgical treatment were essential for successful operation on RASV associated with AI.