Bentall术后并发主动脉弓部夹层动脉瘤再次手术病例报道并文献复习

Reoperation of Debakey Type Ⅰ Aortic Dissection after Bentall Procedure: Report of a Case and Review of the Literature

目的总结报道1例Bentall术后并发主动脉弓部夹层动脉瘤再手术体会,探讨其发病原因、手术方法及风险。方法女,39岁,升主动脉瘤并发DebakeyⅠ型主动脉夹层动脉瘤,行Bentall术后2年,再发主动脉弓部夹层动脉瘤,在深低温停循环选择性脑灌注下行"主动脉弓全弓置换+支架象鼻术"。结果术后无并发症,2周后康复出院。结论主动脉夹层患者术后夹层复发与原发病、首次手术方法选择不当、术后血压控制不良等因素有关。DebakeyⅠ型、Ⅱ型主动脉夹层动脉瘤应尽早手术治疗,手术效果满意。

Objective To report the reoperation of Debakey type Ⅰ aortic dissection in one patient after Bentall procedure,review the literature,and explore the cause,surgical methods and risks.Methods The patient was female,39 years old.Two years before,she underwent Bentall procedure for ascending aortic aneurysm and Debakey type Ⅰ aortic dissection.This time,total arch replacement combined with stented elephant trunk implantation was operated for new aortic arch dissection.Cardio-pulmonary bypass methods including deep hypothermic circulatory arrest with selective cerebral perfusion were used.Results There was no postoperative complication.Two weeks after reoperation,the patient was recovered and discharged.Conclusion Aortic dissection relapse is related with primary diseases,inappropriate choice of the first operation,and uncontrolled hypertension after surgery.Patients with acute Debakey type Ⅰ and Ⅱ aneurysm should be operated immediately,and the result is satisfactory.