胸部主动脉病变的外科治疗

目的　总结胸主动脉病变的临床特点及治疗经验 ,探讨手术技术、中枢保护方法及围术期处理策略。方法　回顾分析我科 1995年 12月～ 2 0 0 3年 6月收治的 53例胸部主动脉病变患者的临床资料。包括 :马凡氏综合征 14例、夹层动脉瘤3 1例、降主动脉缩窄 6例、左下肺结核及食管癌侵犯降主动脉各 1例。全组 77 4%患者 (41/ 53 )有高血压病史 ,96 8% (3 0 /3 1)的夹层动脉瘤患者有胸背部撕裂痛史 ,84 6% (11/ 13 )的急性夹层伴有休克。全组病人均接受手术治疗。结果　住院死亡4例 ,其他均痊愈出院 ,随访 4个月～ 8年均健康存活。结论　合理的手术方案、恰当的中枢保护及正确的术后处理是成功治疗胸主动脉病变的关键。

SURGICAL TREATMENT OF THORACIC AORTIC DISEASES

Objective: The purpose of this study is to summarize the cl in ical characteristics and surgical therapeutic experiences in patients with thora cic aortic diseases. Methods: A retrospective study was carrie d out at our institution from Dec. 1995 to Jun. 2003. A total of 53 patients wit h thoracic aortic diseases submitted to surgical treatment were included. The cl inical characters, surgical techniques, cardiopulmonary bypass managements, post operative complications controls, and therapeutic principles were reviewed. In t his series, the types of aortic diseases including: marfan′s syndrome (14 cases ), thoracic aortic aneurysma dissecans (31 cases), coarctation of the descending aorta (6 cases), and descending aortic abnormity (2 cases) caused by the infect ion of pulmonary tuberculosis in left lower lobe and the local aortic invasion o f esophageal carcinoma respectively. 77 4% (41/53) of these patients had medica l history of hypertension, 96 8% (30/31) of them complained of a severe pain in their chest or back, and 84 6% (11/13) of patients with acute aortic aneurysma dissecans demonstrated shock as comorbidity. All patients were managed surgical ly with or without cardiopulmonary bypass for replacement of the destroyed aorta . Some of them were also received aortic valve repairing or replacement at the s ame time. Result: 49 of 53 (92 5%) patients were successfully cured. In 4 months to 8 years follow-up, they are all alive and in good condit ion. There were 4 of 53 early deaths (7 5%) in this series. Conclusion : In the treatment of thoracic aortic diseases, choosing the rational o perative modalities, protecting the functions of central nervous system appropri ately, and controlling the development of postoperative complications efficientl y, can help to improve outcomes.