主动脉窦瘤破裂的手术治疗及临床疗效分析(附48例报告)

Surgical treatmetn of repture of aortic sinus aneurysm and clinical result analysied

自1975年至1996年我院共行外科治疗主动脉窦瘤破裂（又称华氏窦瘤破裂）48例。其中男27例，女21例。年龄最大54岁，最小6岁，平均29．4岁。窦瘤起自右冠状窦者的例（95．8％），无冠状窦者2例（4．2％）。窦瘤破人右室23例（47．9％），右室流出道对例（42％），破入右房4例（8．3％）破入左室1例（2．1％）。破口最小3mm，最大15mm，平均8．5mm。全组合并室缺27例（56％），合并主动脉瓣关闭不全22例（45.8％）。手术后4个月死亡1例，死于心内膜炎。本组手术多采用破入口切口，合并主动脉瓣关闭不全者则行双切口，切开主动脉根部进行修补。窦瘤破裂除5例作单纯缝合外，另30例用扣或垫片缝闻窦瘤后再缝合加固，13例用补片加缝合修补。合并室缺者均子以修补，合并主动脉关闭不全的22例中7例行换瓣治疗，4例作主瓣整形，11豆例未作处理。全组手术效果满意，随诊3个月~10年，平均2年3个月。手术效果与术前心功能、是否合并主动脉瓣关闭不全以及窦瘤修补技术相关。本文介绍窦瘤的修补方法和合并畸形的处理以及临床疗效的分析。

From 1975 through (early)1997 this hospi tal has conducted 48 cased of surgical therapy on aortic sinus aneurysm ruptrue where 27 cases were for male and 21 forfemale. Counting on age, the eldest was 54 and the youngestwas 6, averaged 29.4 years old. As to the position of origin,46 cases (95.8%) of sinus aneurysm were generated on right coronary sinus and those non coronary sinus occupied 2cases (4. 2%). And to the rupture, there were 23 cases(47% ) that the sinus aneurysm brolen into the right ventri cle,20 cases (42%) of the right ventricular outflow tract,while 4 cases (8. 3%) borken into the right atrium and 1case (2. 1%) of rupture went into the left atrium. The snalest fracture was 3mm in diameter while that of the largestwas 15mm, averaging 8.5mm. In the whole group of exam ples, 27 cases (56%) complicated ventriclar septlal defectand 22 cases (45. 8%) combined theaortic incompetence(Al).There was 1 death case 4 months after the opeeration.from infective endocarditis.The operation of this group majorly managed cutting atthe rupture while for AI it applied bilateral cutting to cut theroot of the arota for repair. To the sinus aneurysm rupture,other than the 5cases of simple suturing,the other 30 cases had applied mending by patching for fastening after sututing the sinus aneurysm with button or pad,while 13 cases were mended by adding patch to suture.For patients closing ventri ventricle defect, all were mended.In 22 cases of AI, 7 cases havetaken valve replacement, 4 cases adopted main valve plasticoperation and the remainder 11cases kept untreated.The effect of the whole group of operation was satisfactory ,by a fol low -up of 3 months to 10 years,averaging 21/4 years.The result is closely related to the pre -operation heartfunction, the complicated AI as wall as the technigue mend ing the sinus aneurysm. The article introduced the mending method for the sinusaneurysm the treatment of coplicated the deformity as wellas the analysis on clinical results.