胸部主动脉瘤的外科治疗

Surgical treatment of thoracic aortic aneurysm

作者自１９９０年４月至１９９４年１２月共收治了各类胸主动脉瘤８０例，其中进行手术治疗共６１例，分别为Ｂｅｎｔａｌ手术３５例，Ｗｈｅａｔ手术３例，主动脉峡部瘤切除术３例，降主动脉瘤人造血管置换术１４例，其他６例。总手术死亡率为６％。１９例非手术治疗组中，有８例于术前动脉瘤破裂，５例死亡，３例出院后其中２例半年后死亡。在有夹层形成的４９例中，Ａ型夹层动脉瘤２８例，Ｂ型夹层动脉瘤２１例（Ｓｔａｎｆｏｒｄ分类法）。手术成功的重要因素是预防术后大出血，心律失常和感染。

In 80 patients with thoracic aortic aneurysm were treated in our hospital, 62 were males and 18 females. Their age ranged from 20 to 73 years. The aneurysm lesions involved ascending aorta in 45 patients (Marfan′s syndrome),aortic isthmus segment in 3,descending aortic aneurysm in 26, and thoraco abdominal aneurysm in 3.Thoracic aortic aneurysm with dissecting aneurysm were found in 49.Stanford type A was present in 28 cases patients and type B in 21 61 patients underwent surgery including Bentall′s operation in 35, Wheat′s operation in 3,resection of discending aortic aneurysm with vascular prosthesis grafting in 14, and other types of operation in 9 Operative mortality rate was 6%. In the medically treatment group of patients, spontaneous rupture of the aneurysm occurred in 8. Among them, 5 died in hospital and another 2 at home.In this series of patients, Marfan′s syndrome and dissecting aneurysm were the predominant pathological lesion.Since acute rupture of dissecting aneurysm is the main cause of death, surgical treatment should be immediate after the diagnosis is established.In the chronic dissecting aneurysm, early surgical treatment also should be considered.