胸主动脉瘤的外科治疗

Surgical treatment of aneurysm of thoracic aorta

目的 :总结 7例胸主动脉瘤病人的外科治疗经验。方法 :7例病人中胸降主动脉瘤 2例 ,主动脉根部瘤 (马凡综合征 ) 2例 ,夹层动脉瘤 3例 ,均为II型夹层动脉瘤 ,其中 1例合并冠心病 ,前降支单支病变。胸降主动脉瘤在低温体外循环下行人工血管置换术。升主动脉瘤和II型夹层动脉瘤在低温体外循环下行Bentall手术 ,其中 1例采用带管道无支架生物瓣 ,同时行冠脉搭桥手术。结果 :6例存活 ,1例死于低心排综合征。结论 :在胸主动脉瘤的外科治疗中 ,Bentall手术是治疗升主动脉瘤较好的手术方法。外科手术技术是手术成功的重要因素。体外循环管理 ,良好的心肌保护和血液保护是保证手术成功的重要手段。带管道无支架生物瓣对老年人及抗凝有禁忌或主动脉根部较小者更适宜 。

? Objective To review the surgical results of aneurysm of thoracic aorta. Methods From June 2000 to July 2002, 7 patients with aneurysm of thoracic aorta underwent surgical treatment,in which 2 were descending thoracic aorta, 2 marfan's syndrome, 3 type II aortic dissecting aneurysm, one of which was united with coronary heart disease.The patients with aneurysm of descending thoracic aorta were were performed vascular prosthesis replacement.The patients with aneurysm of ascending thoracic aorta and type II aortic dissecting aneurysm were performed Bentall. One of them used stentless bioprosthesthesis and performed coronary artery bypass graft at the same time. Results There was 1 postoprative death caused by low cardiac output syndrome and others recovered favorably. Conclusion In surgical treatment of aneurysm of thoracic aorta, Bentall is a good procedures to treat aneurysm of ascending thoracic aorta. Surgical technique is the most important agent. Management of cardiopulmonary bypass, satisfactory myocardial preservation and blood preservation are important procedures to assure the success of operation. Stentless bioprosthesthesis is better for old patients and those who have contraindication of anticoagulant or small root of aorta. Coronary artery bypass graft should be performed in those patients who are complicated by coronary heart disease.