De Bakey Ⅲ型主动脉夹层的外科治疗

Surgical treatment of De Bakey type Ⅲ aortic dissection

目的 总结DeBakeyⅢ型主动脉夹层的外科治疗经验并探讨其手术指征、方法和血泵法全血回收、动脉输入在术中的作用。 方法 DeBakeyⅢ型主动脉夹层患者 4 9例 ,行部分胸主动脉替换术 35例 ;部分胸主动脉替换加胸主动脉成形术 4例 ;全胸主动脉替换术 8例 ;胸腹主动脉替换术2例。其中 35例采用血泵法全血回收、动脉输入技术。 结果 本组患者死亡 3例 ,病死率 6 1% ;其中急诊手术 8例 ,死亡 1例 ;择期手术 4 1例 ,死亡 2例。永久性脊髓损伤 1例 ,发生率 2 0 %。 结论DeBakeyⅢ型主动脉夹层手术治疗的病死率及并发症发生率均较高。因此 ,采用适宜的手术方法及脊髓保护方法是解决问题的关键 ;在术中应用血泵法全血回收、动脉输入技术可明显减少输血量 ,对脊髓、肾脏也有一定的保护作用。

Objective To summarize the experience in surgical treatment of De Bakey type Ⅲ aortic dissection and discuss the operative indications, techniques, and methods for spinal cord protection Methods From January 1994 to January 2000, 49 patients with De Bakey type Ⅲ aortic dissection were operated on. Of these patients, 35 were subjected to partial thoratical aorta replacement, 4 partial thoratical aorta replacement and plasty, 8 total thoratical aorta replacement, and 2 thoracoabdominal aorta replacement. In the 35 patients, the operations were performed by using the technique which preserved blood was transfused back by pump via the femoral artery. Results Hospital mortality in this group was 6 1% (3/49) Eight patients received emergence operation, and 1 patient died. Paraparesis developed in one patient (2 0%) Other complications included re exploration for bleeding in 3 patients, and wound infection in 5. Conclusions The rate of mortality and complication is high in patients with De Bakey type Ⅲ aortic dissection. Appropriate operative techniques and methods of spinal cord protection are essential to resolve this problem.