外科治疗成人主动脉缩窄40例

Surgical management for 40 adult patients with aortic coarctation

目的探讨成人主动脉缩窄的手术方式、手术效果、随访结果并总结临床经验。方法回顾性分析2004年7月至2015年3月我院行外科手术治疗的40例成人主动脉缩窄患者的临床资料,其中男28例、女12例,年龄16~57(26.3±11.0)岁,根据手术前后上下肢平均压差的变化及术后呼吸机辅助时间、住ICU时间、总住院时间等评估手术效果。结果 40例手术均顺利完成,1例合并急性主动脉夹层的患者术后死亡,其余患者均治愈出院。随访12~36个月,术后上下肢平均压差较术前均明显缩小。至出院时仍有6例患者存在高血压,需要持续药物治疗。结论外科手术是治疗成人主动脉缩窄的有效手段。合并心内畸形者应用解剖外旁路转流技术同期手术处理主动脉缩窄安全、有效。

Objective To summarize the experiences of the surgical management for adult patients with aortic coarctation. Methods Clinical data of 40 adult patients diagnosed with aortic coarctation undergoing surgical repair in our center between July 2004 and March 2015 were retrospectively analyzed. There were 28 males and 15 females with a mean age of 26.3± 11.0 years （ranging 16-57 years）. We evaluated the effect of surgery by the change of pressure gradient between upper limb and lower limb, mechanical ventilation time, and length of ICU stay and hospital stay. Results Forty surgeries were finished successfully. One patient died after surgery. The follow-up ranged from 12 to 36 months. The mean pressure gradient reduced significantly after surgery. There were 6 patients suffering blood hypertension at their discharge, and all of them still need antihypertensive drugs. Conclusion Surgical repair is an effective treatment for adult with aortic coarctation. Extra-anatomic ascending-to-descending aortic bypass and concomitant repair of intracardiac anomalies is safe and effective.