升主动脉瘤的外科治疗

Surgical treatment of ascending aortic aneurysm

目的总结升主动脉瘤的临床诊断和外科治疗经验。方法自2003年3月至2008年11月，20例升主动脉瘤患者中马凡综合征11例、升主动脉瘤伴主动脉瓣关闭不全3例、单纯升主动脉瘤3例、急性夹层动脉瘤伴主动脉瓣关闭不全2例、升主动脉瘤伴主动脉瓣关闭不全并感染性心内膜炎1例。行单纯Bentall手术10例、Bentall手术加右半弓人工血管置换2例、Wheat手术4例、Cabrol手术1例、David手术1例、主动脉瓣置换加主动脉弓置换加象鼻手术1例、主动脉瓣置换术加升主动脉成形术1例。结果全组无手术死亡和术后严重并发症发生。结论早期诊断、精细的手术操作技巧、据病情选择合适的手术方式，是改善升主动脉根部瘤患者预后的关键。

Objective To summarize the diagnosis and surgical treatment of ascending aortic aneurysm. Methods Twenty patients with ascending aortic aneurysm were operated from Mar 2003 to Nov 2008, eleven cases with Marfan syndrome, 3 cases ascending aortic aneurysm and aortic valve regurgitation, 3 cases ascending aortic aneurysm,2 case acute dissecting aortic aneurysm and aortic valve regurgitation, 1 case ascending aortic aneurysm and aortic valve regurgitation and infectious endocarditis. Bentall operation was performed in 10 cases, Bentall operation and hemiarch replacement in 2 cases, Wheat procedure in 4 cases, Cabrol procedure in 1 cases, David procedure in 1 cases , total arch replacement and elephant trunk procedure in 1 cases , aortic valve replacement and ascending aortoplasty in 1 case. Results In the whole group, there were no operative death and serious postoperative complications. Conclusion It is very important to improve prognoses of aortic aneurysm that early diagnosis, meticulous operative technique and method should be decided according to different feature.