主动脉瘤外科综合治疗

The generalized surgical treatment of aortic aneuryam

目的总结主动脉瘤外科综合治疗经验。方法主动脉瘤92例(马方综合征7例,DebaKey夹层动脉瘤85例),实施了主动脉半弓或全弓置换和/或腔内支架植入术。结果本组85例治愈,术后早期死亡7例(死亡率7.6%)。77例随访5个月～16年2个月,除1例并发截瘫者术后1年半因褥疮伴感染死亡,其余心功能(NYHA)恢复至Ⅰ级50例,Ⅱ级21例,Ⅲ级5例。结论根据病变部位、程度,包括导管植入支架、杂交手术等综合治疗可以简化手术操作,提高手术安全性,降低主动脉瘤病死率。深低温停循环经上腔静脉逆行灌注是一种简便可行有效的脑保护方法。

Objective To summarize the experience of generalized surgical treatment of aortic aneuryam. Methods The saintor total aortic arch replacement and/or endovascular stent graft exclusion were performed in 92 patients with aortic aneurysm including Marfan syndrome in 7 cases and DeBakey dissecting aortic aneuryam in 85 cases. Results Of 92 patients,85 cases were cured and 7 cases（7.6%） died at early stage. Seventy-seven cases were followed up for 5 months to 16 years and 2 months, of which one patient complicated with paraplegia and died of infection and the others were living healthily with NYHA heart function classified as grade Ⅰ in 50 cases,grade Ⅱ in 21 cases and grade Ⅲ in 3 cases. Conclusion According to diseased region and extent, seleting combined surgery including endoluminal stent grafting and hybrid technique may simplify surgical procedure, improve safety and reduce mortality in patients with aortic aneuryam. Circulatory arrest under deep hypothermia with retrograde cerebral perfusion is a convenient and effective way for brain protection.