Cabrol手术治疗主动脉夹层的改良

Clinical usage and improvement of cabrol procedure in aortic dissection aneurysm

目的:介绍主动脉夹层的外科Cabrol手术治疗方法的改良。方法:自1993年3月～2005年6月采用改良的Cabrol手术方法为16例主动脉夹层患者进行了升主动脉夹层切除、主动脉瓣和升主动脉替换加GoreTex管冠状动脉开口连接。16例中,4例为DebakeyⅠ型,12例为DebakeyⅡ型。改良的Cabrol手术在原Cabrol手术的基础上进行了4项改进。结果:16例患者均顺利恢复,平均随访时间8年,1例随访时间达12年,均未发现主动脉夹层再发,未发现假性动脉瘤形成,心功能均恢复达到Ⅰ级。结论:改良的Cabrol手术治疗DebakeyⅡ型和夹层内口位于升主动脉的DebakeyⅠ型主动脉夹层,治疗效果均很满意,有其特定的实用价值和应用前景。

Objective：To review the surgical results and experience of aortic dissection aneurysm in 16 cases. Method：From March 1993 to June 2005, 16 patients with aortic dissection aneurysm（4 cases of DeBakey Ⅰ , 12 cases of DeBakey Ⅱ ） underwent total replacement of the ascending aorta and reimplantation of the coronary arteries as Carbrol＇s procedure. Anastomosis of coronary openings with 8 mm Gore-Tex tube, seating the end of Gore-Tex tube onto coronary ostia like a cage to obtain good match with no tension, and to avoid intimal tear around coronary ostia and blood leakage of the anastomosis; A self infusion system was used to stop hemorrhage of vessel graft of anastomosis by bypass between right atrium and aneurismal Sac with Gore-Tex graft and obtained excellent result; Operative sequence in basic eabrol＇s procedure was modified; Tapled anastomosis was used in posterior wall of distal dissecting aorta. Result： All of the 16 patients recovered uneventfully. Conclusion：The modified cabrol＇s procedure can produce a satisfactory clinical result in the treatment of aortic dissection aneurysms.