15例主动脉夹层动脉瘤的外科治疗

Surgical treatment of aortic dissecting aneurysm

目的 总结 1992年 6月至 1998年 6月对 15例主动脉夹层动脉瘤病人的外科治疗经验。方法 采用Cabrol手术 6例 ,Bentall手术 4例 ,升主动脉与腹主动脉搭桥转流手术 4例 ,升主动脉夹层缝闭加主动脉瓣成形 1例。结果 14例生存 ,1例Bentall手术左冠状动脉吻合口出血者死亡。结论 DeBakeyII型病人 ,当冠状动脉开口直接缝合于带瓣管道上有困难时 ,采用Cabrol手术有其优点———采用 1根 8mm直径的Gore Tex管与左、右冠状动脉开口进行连接吻合 ,吻合口没有张力且对合严密 ,避免了冠状动脉开口周围内膜撕脱和吻合口漏血。对手术后无法止血的轻微升主动脉漏血和左心室漏血 ,采用瘤袋或自体心包包裹漏血区 ,其后与右心房进行搭桥吻合 ,将漏血引入右心房 ,形成“自体输血循环”达到止血目的。对于DeBakeyIIIa型手术切除有困难者 ,采用升主动脉与腹主动脉搭桥转流手术 ,可以延缓病变的发展 。

Objective To review the surgical results of aortic dissecting aneurysm. Method from June 1992 to June 1998,15 patients with aortic dissecting aneurysm underwent surgical treatment. The procedures performed included 6 Cabrol operation, 4 Bentall procedure, one of closure of dissection with aortic valvular plasty and 4of deviation bypassing the dissected aorta. Results There was 1 postoperative death with a mortality of 6 6%. The cause of death was leakage of the anastomosis of left coronary in Bentall procedure. Conclusion The modification of Cabrol operation could improve surgical outcome of type II aortic dissection aneurysm. A selfblood infusion system bypass is created in case of hemostatic failure between right atrium and aneurysmal sac sewn around the dacron graft. For type IIIa aortic dissection aneurysm, a dacron graft was implanted between ascending aorta and abdominal aorta to bypass the dissected aorta, the results are encouraging.