胸主动脉病变的外科治疗

The Surgical Treatment of the Thoracic Aorta Disease

目的：总结近年我院完成的24例胸主动脉病变的治疗经验,通过对临床手术资料的分析,明确胸主动脉瘤手术的适应证及手术方法,积累胸主动脉病变手术的成功经验。方法：胸骨正中切口,常规中低温体外循环,经股动脉或主动脉近弓部插管,上下腔静脉插管,直接经冠状动脉开口晶体液灌注停跳。作升主动脉斜形切口、＂S＂形切口或＂I＂字切口。行单纯升主动脉人工血管置换术4例;主动脉瓣环加宽、主动脉瓣置换及升主动脉成形术3例;二尖瓣、主动脉瓣置换并升主动脉成形术7例;单纯Bentall手术6例;二尖瓣＋Bentall手术1例;Wheat手术1例,Wheat手术＋冠状动脉搭桥术1例;Bentall手术＋全降主动脉、双髂动脉人工血管置换术1例。术中止血困难行主动脉根部→右房分流4例。结果：本组24例病人,术后早期低心排5例,二次开胸1例,手术死亡1例（死于术后出血及低心排）,余病人均治愈出院。术后随访2个月~6年,心功能Ⅲ级1例,晚期死亡1例。复查彩超无瓣周漏及心内膜炎,机械瓣活动良好,且升主动脉内径均较术前明显缩小（人工血管除外）。结论：胸主动脉病变一经发现,应积极手术,有利于改善心功能,防止动脉瘤破裂,能明显提高患者的生存质量和延长生存时间。

Objective：Summary and analyze the clinical experiment and information of the thoracic aorta disease which we have treated 24 cases to define the operative indication and methods of the thoracic aneurysm and accumulate the succeed experience of the operation.Method：Using the thoracic midlian incision and hypothermia in extracorporeal cardiopulmonary,intubating through femoral artery or the bow of aorta and the superior /inferior caval vein,infusing the liquid which stop the cardiac muscle contracting through the outlet of coronary artery directly.Using the declivent incision and ＂S＂ incision or＂I＂ incision in ascending aorta.There were 4 cases whose ascending aorta was replacede by the prosthetic vessel,enlarged the ring of aortic valve and replaced the aortic valve and made Aortoplasty in 3 cases,mitral valve 、aortic valve replacement and Aortoplasty in 7 cases;Bentall operation in 6 cases;mitral valve and Bentall operation in 1 case,Wheat operation in 1 case,coronary artery bypass grafting and Wheat operation 1 case,Bentall operation and the whole of descending aorta、both of Iliac Artery prosthetic vessel replacement 1 case.4 cases carried out the shunt from the root of aorta to Atrium dextrum because the bleeding is in a large amount during the operation.Result：24 cases patient,5 cases occured low out put post operation in early,1 case was surgeried secondly,1 case was death that the reason is low out put and bleeding post operation,the others were all cured.Followed up from tow month to six years after operation,1 case whose heart function is Ⅲ grade and 1 case died in advanced stage.Review the color ultrasound： without perivalvular leakage and endocarditis,the mechanical valve active well and the ascending aorta is smaller obviously than before operation（except artificial blood vessel）.Conclusion：We must carry out the surgical treatment when the thoracic aorta diseases are diagnosised.It is helpful to change the function of heart,avoid the thoracic aorta rupturing and improve the patients＇ life quality to rolong life span.