14例胸腹部动脉瘤临床治疗经验分析

Clinical Experience of Thoracic and Abdominal Aortic Aneurysm on 14 Patients

目的探讨胸腹部动脉瘤的治疗经验．方法14例动脉瘤中，升主动脉瘤伴主动脉瓣关闭不全3例，胸降主动脉瘤6例，胸腹主动脉瘤1例，腹主动脉瘤4例．行Bentall手术2例，Cabrol手术1例，瘤切除人工血管置换2例，主动脉内覆膜支架9例．结果早期死亡2例（14．3％），其余12例痊愈．随访6个月至2a，除1例合并喉返神经损伤伴声音嘶哑外，其余11例疗效良好．结论应根据动脉瘤的病变部位、范围采取不同的手术方式或介入治疗；尽可能彻底切除病变和使用准确的吻合技术，保留瘤壁进行包盖，使胸腹部动脉瘤的手术治疗曼安全；主动脉内覆膜支架术符合血液动力学的要求，而且手术风险小，尤其适合DeBakeymB型夹层动脉瘤，值得推广．

Objective To study clinical experience on treating thoracic and abdominal aortic patients with thoracic and abdominal aneurysm were diagnosed, including 3 cases for ascending aortic aneurysm combined with aortic valve regurgitation, 6 cases for descending thoradc aortic aneurysm, 1 case for thoraco-abdominal aneurysm and 4 cases for abdominal aneurysm. Two cases were treated with Bentall operation; 1 case was treated with Cabrol operation; 2 cases were treated with aneurysm dissection plus graft replacement. The other 9 cases were treated with endovascular stent-graft. Results Early death for 2 cases（ 14.3 % ）, others were discharged from hospital. 6 months-2 years after operation, one case combined with nervous system complication, others have a better outcome. Conclusion According to extents of aneurysm, some methods can be selected. Complete dissecting and better technician is necessary, preserving the covers can make operation more safety; endovascular stent-graft may be a better selection for DeBakeyⅢ B dissection aneurysm.