升主动脉瘤的外科诊治

Strategy of surgical treatment of aortic aneurysm

目的 :结合外科治疗 5 7例升主动脉瘤的经验 ,探讨此病的诊断、手术适应证和手术技术及体外灌注方法 .方法 :我院升主动脉瘤手术 5 7(男 4 6 ,女 11)例 ,年龄 18～ 6 3岁 .其中单纯升主动脉瘤 4 3例 ,DeBekeyI型主动脉夹层 11例 ,De BekeyⅡ型主动脉夹层瘤 3例 ,瘤体直径 5～ 16cm .手术以复合带瓣人工血管组件替换主动脉根部 5 3例 ,保留主动脉瓣的升主动脉替换术 4例 .结果 :1990 0 5 / 1998 0 5手术 18例 ,死亡 6例 ,病死率为 33% (6 / 18) .1998 0 6 / 2 0 0 1 0 5手术 39例 ,死亡 1例 ,病死率为 3% (1/ 39) .除 2例分别死于心律失常和全身衰竭外 ,余均死于出血 .结论 :升主动脉瘤自然病程险恶 ,外科治疗是最有效的方法 .一旦确诊 ,如升动脉瘤直径超过 5cm 。

AIM: To discuss the surgical treatment of a or tic aneurysm including the diagnosis, indications,and surgical techniques,and c ardiopulmonary bypass methods with our operative experience of 57 cases aortic aneurysm.METHODS : Between May 1990 and May 2001,57 patients with aortic aneurysm wer e underwent aortic root replacement in our institution.Male were 46 and female 11,raining in age from 18 to 63.Of 43 cases belonged to DeBekey I dissection,and 3 cases DeBekey Ⅱdissection.The diameter of the aneurysms varide from 5 to 16 cm.Aortic root replacement was operated with composite vale graft in 53 cases,and other 4 cases of aortic valves were reserved.RESULTS: The operative mortality was 33%(6/ 18)from 5,1990 to 5,1998,yet the mortality decreased greatly to 3%(1/39) from 6, 1998 to 5,2001.All 5 cases died from bleeding except 2 cases.CONCLUSION: Aortic aneurysms are serious in the nature of their course,for they will eventually pro duce disability or their course,for they will eventually produce disability or death in many parients.Fortunately,effective surgical therapy is available for all of these conditions,as a result of immediate survival occurring in most of these cases.Therefor,if the diameter of the aneurysm is greater than 5 cm,the patient should be operated as soon as possible.