成人型复杂主动脉缩窄的外科治疗

Surgical treatment of adult complex aortic coarctation

目的探讨成人型复杂主动脉缩窄的外科治疗方法及临床效果。方法回顾性分析2005年12月至2012年7月间经非体外循环下行升主动脉一腹主动脉搭桥手术治疗的6例成人型复杂主动脉缩窄患者的临床资料。结果本组无围术期死亡病例，术后患者症状明显好转，下肢血压升高，上下肢收缩压差〈10mmHg（1mmIHg=0．133kPa），出院随访5～9个月，6例患者血压均恢复正常，复查CT血管造影显示人工血管血流通畅，未出现主动脉再狭窄、假性动脉瘤等并发症。结论非体外循环下经正中胸腹联合切口升主动脉一腹主动脉搭桥手术治疗成人型复杂主动脉缩窄疗效确切，手术操作虽略显复杂，但安全度较高，适于临床选择应用。

Objective To investigate the therapeutic methods and clinical effect of adult com-plex aortic coarctation. Methods The clinical data of 6 patients with adult complex aortic coarctation treated by off-pump descending ascendens aorta-aorta abdominalis bypass surgery between December 2005 and July 2012 were retrospectively analyzed. Results There was no death case during the perioperative period in this study; patients showed a substantial improvement in symptoms after the surgery, blood pressure of the lower limbs were elevated, systolic blood pressure difference between the limbs was 〈 10 mm Hg（ 1 mm Hg =0. 133 kPa）. From 5 to 9 months follow-up visit after the 6 patients left hospi- tal, the blood pressure of them was resumed normal. Their angiography by CT showed that, the blood flow in artificial blood vessel of the patients was unobstructed, there was no aorta restenosis or false aneu-rysm complication. Conclusions The curative effect of off-pump descending ascendens aorta-aorta ab-dominalis bypass surgery on adult complex aortic coarctation is significant; also the operation technique is a little complex, but it has a high degree of safety and is suitable for clinical application.