Standford A型急性主动脉夹层分离手术治疗体会

SURGICAL TREATMENT IN ACUTE THORACIC AORTIC DISECTION ON TYPE-A AORTIC ANEURYSM

目的总结Standford A型急性主动脉夹层的手术治疗经验。方法对我院2002～2007年17例Standford A型急性主动脉夹层手术病人资料进行总结。结果17例病人中住院期间死亡3例,1例死于凝血机制紊乱并大出血,1例因术前并大面积心肌梗死术后发生严重低心排综合征死亡,1例因肾衰竭后并发肺部、纵隔重度感染死亡。1例手术后2年死于主动脉瘤复发。围手术期2例发生呼吸功能不全,1例二次开胸止血,1例发生上消化道出血,1例发生迟发性心包填塞,均经救治后痊愈。结论缩短等待手术时间、熟练的手术技巧和重要脏器的保护是提高手术成功率的关键。

Objective To summarize the surgical experience of acute thoracic aortic disection （AAD） of Type A aortic aneurysm. Methods Clinical data of 17 patients with Type-A AAD were retrospectively analyzed. Results Three patients died during hospitalization： one died of uncontrolled bleeding with coagulation dysfunction, one died of low heart output syndrome caused by acute serious cardiac infarction before operation, and one died of renal failure associated with pulmonary and mediastinum infection. Another one died of recurrence two years after the operation. Perioperative respiratory insufficiency occurred in two patients. Reoperation for massive bleeding was performed in two patients and delayed pericardial temponade was found in one. All were cured after treatment. Conclusion The key to a successful surgery is short waiting time, skilled technique and intraoperative organ protection.