35例DebakeyⅠ型主动脉夹层外科治疗体会

Debakey Ⅰ aortic dissection：experience and management （35 cases）

目的总结DebakeyⅠ型主动脉夹层外科治疗经验。方法回顾分析手术治疗35例DebakeyⅠ型主动脉夹层患者的临床资料。均采用深低温停循环（DHCA）和有选择性的进行脑保护，急诊手术28例，择期手术7例。Bentall术加全弓置换加术中硬支架置入术23例，其中2例加行二尖瓣置换术，改良的Wheat术加全弓置换加术中硬支架置入术6例，升主动脉加全弓置换术加术中硬支架置入术6例。结果全组患者手术死亡4例（11．4％），均为急诊手术死亡（14．3％）。术后近期死亡1例（2．9％），术后CT随访9—33个月，夹层闭合良好，移植物通畅，无扭曲及移位。结论对于DebakeyⅠ型夹层患者应积极果断予以手术治疗，个体化的手术方法、操作技巧和脑保护措施是手术成功的关键。

Objective To summarize the surgical experience on Debakey Ⅰ aortic dissection. Methods Thirty - five patients with Debakey Ⅰ aortic dissection underwent surgical treatment. The operations were all performed by using deep hypothermic circulatory arrest （DHCA） and selected cerebral perfusion. Bentall and total arch grafting with Frozen elephant trunk procedure was carried out in 21 cases, mitral valve replacement in 2 cases, wheat and total arch grafting with frozen elephant trunk procedure in 8 cases, and ascending and total arch grafting with frozen elephant trunk procedure in 6 cases. Results Operative mortality was 11.4% （all deaths occurred in urgent surgery）. One died soon after operation, and the remaining 30 patients recovered within the follow - up period of 9 to 33 months using CT examination. Conclusion Surgery is an effective way in Debakey Ⅰ aortic dissection treatment. Proper surgical indication, technique and brain protections are the key for Debakey Ⅰ aortic dissection surgery.