胸主动脉瘤及主动脉夹层65例外科综合治疗总结

COMPREHENSIVE SURGICAL TREATMENT ON THORACIC AORTIC ANEURYSM AND AORTIC DISSECTION

目的回顾总结65例胸主动脉瘤及主动脉夹层的治疗体会。方法自2001年5月-2008年11月收治65例胸主动脉瘤及主动脉夹层患者,据其病变类型不同采取了不同的治疗方法,其中31例DeBakeyⅠ、Ⅱ型在全麻低温体外循环下施行血管置换手术,34例DeBakey Ⅲ型主动脉夹层患者行主动脉腔内覆膜支架植入术。结果全组65例,2例因术后出血死亡,1例DebakeyⅢ型患者于支架植入术后8 h瘤体破裂死亡,1例发生中枢神经损害。随访6～96个月,1例死于肾脏恶性肿瘤,1例Marfan综合征患者术后12个月腹主动脉再次夹层破口,行第2次手术,1例术后18个月不明原因猝死,其余58例均生存良好。结论胸主动脉瘤及主动脉夹层,根据病变类型不同采取不同的治疗方法,可收到满意疗效。

Objective To review and summarize the treatment on 65 cases of thoracic aortic aneurysm and aortic dissection. Methods＇From May 2001 to November 2008, different methods were adopted in treating 65 cases of thoracic aortic aneurysm and aortic dissection according to different lesion types, 31 cases of DeBakey I, II of which were performed the vascular replacement under hypothermic cardiopulmonary bypass and general anesthesia, and 34 cases with Debakey III were given aortic endovascular stent-graft implantation. Results Among 65 cases,58 were a good survival, except that, 2 died of postoperative bleeding, 1 with Debakey III of aneurysm rupture 8 hours after operation, and 1 suffered from central nervous system damage. During the follow-up of 6 to 96 months, 1 patient died of kictney cancer, 1 with Marfan syndrome was operated for the second time for abdominal aortic dissection breaking again 12 months after the first operation, 1 patient died inexplicably 18 months later. Conclusion Different methods according to different lesion types in treating cases of thoracic aortic aneurysm and aortic dissection will have satisfactory effect.