大动脉炎外科治疗的经验和新进展(附236例报告)

目的探讨对大动脉炎所致的主动脉及其分支狭窄或阻塞,以及升主动脉扩张所致的心脏瓣膜损害外科治疗的经验和新进展.方法自1962年4月至2002年6月共手术治疗大动脉炎236例,其中施行血运重建术131次,包括头臂动脉血运重建术8次,胸、腹主动脉血运重建术60次(升主动脉-腹主动脉人工血管搭桥术47次),其他动脉血运重建术59次;肾切除术106次;主动脉瓣置换或主动脉根部置换术20例.结果术后手术死亡率为2.12%(5/236),死于血运重建术后血管再阻塞4例,凝血机制障碍1例;平均随访8.2年,随访死亡19例,远期死亡率为8.23%;再次手术19例,再手术率为8.23%.其中因血运重建失败或大动脉炎进展再次手术12例,主动脉瓣置换术后瓣周漏再次手术7例.5年及10年生存率分别为93.1%和90.1%.结论手术时机和手术方法的选择,以及术前、术后长期抗炎治疗有助于提高大动脉炎患者的外科疗效.

Experience and new progression of surgical treatment for aortoarteritis :an analysis of 236 patients

Object To investigate the surgical results in patients with obliteration of multiple large arteries and aortic insufficiency caused by aortoarteritis. Method 236 patients with aortoarteritis were treated from 1962 to 2002. Procedures included carotid reconstruction(8), aortic reconstruction (60,including 47 cases of ascending-abdominal bypass), renal arterial bypass(59), nephrectomy(106) and aortic valve/aortic root replacement(20). Result There were 5 operative deaths(2.12%), four due to obliteration of bypass and one due to hemorrhage. 19 patients died after a mean follow-up time of 8.2 years.19 patients required a reoperation, 12 due to failure of arterial reconstruction or progress of aortoarteritis, 7 due to postoperative perivalvular leakage. The actuarial survival rate was 93.1% at 5 years and 90.1% at 10 years. Conclusion The opportunity of the operation, selection of operative procedure, and long-time control of active inflammation were essential for successful treatment of aortoarteritis.