114例升主动脉瘤的外科治疗

Surgical Treatment of Ascending Aortic Aneurysm in 114 Patients

目的 总结升主动脉瘤手术治疗的经验 ,并分析探讨其相关的问题。 方法 对 114例升主动脉瘤患者(其中 6 2例伴升主动脉夹层分离 )施行了手术治疗。 10 5例升主动脉瘤伴主动脉瓣关闭不全患者行 Bentall手术 (升主动脉和主动脉瓣置换术以及冠状动脉开口移植术 ) ,其余 9例患者仅行升主动脉置换术。 结果 手术死亡 7例(6 .14 % ) ,其中 6例为术前心功能 (NYHA) 级患者。随访 10 7例 ,随访时间 7天～ 12 .4年 (40± 30月 ) ,死亡 8例 ,死于颅内出血 3例 ,腹内动脉瘤破裂出血 3例 ,急症冠状动脉旁路移植术 1例 ,原因不明猝死 1例。存活的 99例(86 .8% )情况良好 ,心功能为 、 级。 结论 主动脉置换术治疗升主动脉瘤、Bentall手术治疗升主动脉瘤合并主动脉瓣关闭不全 ,术后可使大多数存活患者获得良好的功能恢复和生活质量 ,手术效果满意。

Objective To summarize experience of surgical treatment of ascending aortic aneurysm and analyse related problems. Methods One hundred and fourteen （containing 62 cases bad aortic dissection） consecutive cases underwent replacement of diseased ascending aorta alone （9 cases） or Bentall operation. Results There were seven operative death （6. 14%）. The cardiac function, in six of them, was in class Ⅳ （NYHA） preoperatively. Follow-up was completed in 107 patients, with a duration of 40±30 months. Eight patients succumbed due to intracranial hemorrhage （3 cases）, rupture of abdominal aortic lesion （3 cases）, cardiac failure after coronary artery bypass grafting （1 case）, and sudden death of unknown cause （1 case）,respectively. All 99 long-term survivors （86.8%） were in NYHA class Ⅰ or Ⅱ . Conclusion The results indicate that Bentall operation for treating ascending aortic aneurysms and aortic insufficiency, or aortic replacement alone for treating ascending aortic aneurysm gives good functional recovery and an active life for the vast majority of survivors.