DeBakey Ⅰ、Ⅱ型主动脉夹层的外科治疗

目的 总结DeBakeyⅠ、Ⅱ 型主动脉夹层的外科治疗经验，探讨其手术指征、基本方法和手术技术。方法 对131例DeBakeyⅠ、Ⅱ型主动脉夹层患者实施手术治疗，其中25例行升主动脉＋部分主动脉弓替换术，83例行主动脉根部替换术（Bentall‘s手术），10例行升主动脉替换＋全弓替换术，4例行细胞感升主动脉替换＋主动脉瓣替换术（Wheats),3例行主动脉根部替换术＋全弓替换术，4例行“象鼻手术”（(Elephant Trunk)，2例行主动脉根部替换＋象鼻技术。结果 本组死亡4例，死亡率3．05％。急诊手术44例，死亡3例，死亡率6．81％。择期手术87例，死亡1例，死亡率1．1％。结论 早期手术治疗是降低DeBakeyⅠ、Ⅱ型主动脉夹层病死率的关键。右锁骨下动脉插管，深低温停循环结合选择性脑灌注是一种简便易行的脑保护方法，有利于降低该病死亡率和并发症的发生率。

Surgical treatment of DeBakey type I and II aortic dissection]

OBJECTIVE: Aortic dissection is associated with significant mortality and morbidity. Effective methods to treat aortic disection are now available although these lesions still challenge the cardiovascular surgeon. METHODS: From January 1994 to January 2000. 131 patients with DeBakey I, II type aortic dissection underwent surgical treatment. Operations were performed under cardiopulmonary bypass in 59 patients. Hypothermic circulatory arrest was used in 15 patients. Hypothermic circulatory arrest and selective cerebral perfusion was used in 57 patients. A graft replacement of ascending aorta and partial aortic arch was performed in 25 patients, ascending aorta and total aortic arch in 10. 83 patients underwent the Bentall procedure. The Bentall procedure and total aortic arch replacement were performed in 3 patients, the Wheats operation in 4. 4 patients underwent the elephant trunk techniques and 2 patients with the elephant trunk techniques and the Bentall procedures. RESULTS: There were 4 deaths within 30 days after surgery with an operative mortality of 3.05%, and 3 neurological dysfunction undergone hypothermic circulatory arrest. They were recovered within 1 week. CONCLUSION: The operative technique is difficult. Selective cerebral perfusion can provide available protection during surgery of aortic dissection. It prolongs the time allowed to performed the aortic repair.