升主动脉和弓部动脉瘤的外科治疗

Surgical treatment of ascending aorta and aortic arch aneurysm

目的 总结 1990年 1月至 2 0 0 1年 12月对 4 8例升主动脉和弓部动脉瘤患者行外科治疗的经验。 方法3例弓部动脉瘤施行全弓置换术 ,其中 2例采用象鼻技术。 2 9例马方综合征 (Marfan syndrome)施行 Bentall手术 ,其中 2例同时分别施行二尖瓣成形术或二尖瓣置换术 ,3例合并急性夹层动脉瘤。主动脉夹层动脉瘤 16例 ,急性期手术8例 ,慢性期手术 8例 ;其中 Bentall手术 5例 ,升主动脉置换术 5例 ,升主动脉置换加主动脉瓣成形术 4例 ,Wheat手术 2例。 结果 4 3例生存 ,4例手术死亡 ,1例术后早期死亡 ,住院死亡率为 10 .4 %。其中急症手术 11例 ,死亡 4例 ,死亡率为 36 .4 % ;择期手术 37例 ,死亡 1例 ,死亡率为 2 .7%。 结论 按手术紧急程度不同 ,可分为急症手术、尽早手术和择期手术三类。对真性梭形弓部动脉瘤采用非切断腔内吻合术能明显简化手术 ,缩短深低温停循环时间。急症手术 ,动脉瘤破裂和夹层内膜破口侵犯弓部将增加手术风险。

Objective To report the surgical results of 48 patients with ascending aorta and aortic arch aneurysm who receipted surgical treatment from January 1990 to December 2001. Methods Graft replacement of aortic arch were performed in 3 patients with aortic arch aneurysm, and 'elephant trunk' procedure were used in 2 patients. Bentall's operation were performed in 29 patients with Marfan syndrome in which mitral valvoplasty and replacement were performed with separately in 2 cases. In 16 cases of aortic dissecting aneurysm the procedures performed were 5 Bentall operations, 5 graft replacements of ascending aorta, 4 graft replacements of ascending aorta with aortic valvoplasty and 2 Wheat operations. Results There were 4 operative deaths and one postoperative death with hospital mortality of 10.4%. There were hospital mortality of 36.4% in emergency operation and 2.7% in selective operation. Conclusions Indication and opportunity of operation could be divided into emergent operation, immediate operation and selective operation according to urgency and severity of disease. Technique of noncutting anastomosis could simplify the procedure and decrease the period of deep hypothermic circulatory arrest (DHCA) for aortic arch aneurysm. Risk factors of operation include emergency operation, aneurysm rupture and dissecting tear into the proximal aortic arch.