主动脉瘤的外科治疗

主动脉瘤常发生在升主动脉、主动脉弓、胸部降主动脉、胸腹主动脉、腹主动脉。国外报道其相对发生率分别为１０％、７％、１６％、２％和６５％。我们于１９９３年８月～１９９８年４月行手术治疗１２例,疗效良好。１　临床资料与方法１１　一般资料　本组共１２例,男１１例,女１例。年龄２７～７８岁,平均５４岁。升主动脉瘤５例,胸降主动脉瘤２例,胸腹主动脉瘤１例,腹主动脉瘤４例;其中真性动脉瘤６例,假性动脉瘤１例,夹层动脉瘤５例。在５例主动脉夹层动脉瘤中,ＤｅＢａｋｅｙⅡ型２例,ＤｅＢａｋｅｙⅢ型３例。６例真性…     

升主动脉瘤伴主动脉瓣关闭不全外科治疗25例

报告２５例升主动脉瘤伴主动脉瓣关闭不全的手术经验。方法１１例伴有主动脉夹层分离，其中ＤｅＢａｋｅｙⅠ型６例、Ⅱ型５例。施行Ｂｅｎｔａｌ手术１９例，分别置换主动脉瓣及升主动脉１例，升主动脉置换加主动脉瓣悬吊５例。结果因止血困难采用Ｃａｂｒｏｌ分流止血２例；术后１６小时延迟大出血１例；无早期死亡病例。远期因心内膜炎死亡２例；术后３０月发生胸降主动脉瘤１例；无假性动脉瘤发生。结论应根据升主动脉瘤的病变类型及范围采用不同的手术方式。准确的吻合技术、保留瘤壁的完整性，使升主动脉瘤的手术治疗更为安全。心内膜炎是Ｂｅｎｔａｌ手术后最主要的远期并发症，须引起高度重视     

主动脉夹层动脉瘤的外科治疗

回顾性地对１９９０～１９９５年收治的６１例主动脉夹层动脉瘤资料进行分析，探讨其手术治疗原则及治疗效果。其中ＤｅＢａｋｅｙⅠ、Ⅱ型３１例，Ⅲ型３０例。手术治疗４１例，非手术２０例，非手术２０例中１０例在等待手术期间因室颤和心衰死亡５例，突发夹层瘤破裂死亡５例；另外１０例中，２例动脉瘤破裂包裹保守治疗，２例因肾功能严重受损未手术，６例不接受手术出院。非手术组住院死亡率为５０％。手术治疗４１例中ＤｅＢａｋｅｙⅠ、Ⅱ型手术２３例，２０例行Ｂｅｎｔａｌｌ术，３例行Ｗｈｅａｔ术，手术死亡３例，手术死亡率１３％，术后５年死亡率为２０％。ＤｅＢａｋｅｙⅢ型手术１８例，手术死亡２例，死亡率１１．１％，５年死亡率为１２％。故作者认为，主动脉夹层动脉瘤病人应积极手术治疗，ＤｅＢａｋｅｙⅠ、Ⅱ型急性期应手术治疗，Ⅲ型如果无不可控制的高血压、无不能制止的疼痛、瘤体扩大不明显，或有重要脏器缺血受累外，应先严密监测、控制血压，做必要检查后择期手术。     

主动脉弓离断的诊断和外科治疗

自１９８６年１１月至１９９２年６月共施行主动脉弓离断矫治术６例，４例Ａ型，２例Ｂ型，Ａ型患者采用二期手术，Ｂ型患者均一期手术，术后早期死亡１例，术后３个月因败血症死亡１例。作者对本病的手术治疗方法进行了讨论。     

支架型人工血管临床应用的初步经验

目的探讨支架型人工血管治疗各类动脉瘤的临床效果。方法本组包括夹层动脉瘤 4 8例 ;腹主动脉瘤 13例 ;降主动脉、左锁骨下动脉、肾下和肾上腹主动脉假性动脉瘤分别为 4例、1例、2例和 1例 ;左、右髂动脉瘤各 1例。对夹层动脉瘤和假性动脉瘤均行破口封堵术 ,真性腹主动脉瘤行隔绝术。结果本组均获技术成功。围手术期死亡 2例。 5例夹层动脉瘤术后近侧有少量残余漏 ,但 4例半年后近侧渗漏消失 ,9例残存远侧破口少量返流。腹主动脉瘤 6例术后即时有轻度内漏 ,3个月后 5例内漏消失。结论支架型人工血管治疗夹层动脉瘤、假性动脉瘤和真性动脉瘤手术微创、安全 ,但其远期疗效需进一步观察。     

采用进口器具行微创腔内隔绝术治疗Stanford B型夹 …

探讨ＳｔａｎｆｏｒｄＢ型夹层动脉瘤的微创腔内隔绝术治疗的价值及应用经验。方法采用进口器具治疗２６例ＳｔａｎｆｏｒｄＢ型夹层动脉瘤术，术前精确评估，正确选择移植物，ＤＳＡ监控下将移植物导入裂口位置，使假腔与真腔隔绝。结果２６例中，移植植置入全部成功，无术中死亡或中转开腔手术；术中内漏３例，术后３天左上肢动脉血栓形成１例，胸骨后疼痛１例，腹股沟切口延迟愈合２例，术后６天心梗猝死１例。中期结果示假腔内血     

Bentall术中深低温停循环持续上腔静脉逆灌脑保护

Ｂｅｎｔａｌｌ术中深低温停循环持续上腔静脉逆灌脑保护李慧，王恩玉，李毅力病人男，４７岁。诊断为马凡综合征升主动脉瘤合并ＤｅＢａｋｅｒⅠ型夹层动脉瘤、主动脉瓣关闭不全、心功能Ⅲ级。于１９９４年３月在全麻体外循环下行Ｂｅｎｔａｌｌ手术。术中灌注采用右侧股...     

15例主动脉夹层动脉瘤的外科治疗

目的 总结１９９２年６月至１９９８年６月对１５例主动脉夹层动脉瘤病人的外科治疗经验。方法 采用Ｃａｂｒｏｌ手术６例,Ｂｅｎｔａｌｌ手术４例,升主动脉与腹主动脉搭桥转流手术４例。升主动脉夹层缝闭加主动脉瓣成形１例。结果 １４例生存,１例Ｂｅｎｔａｌｌ手术左冠状动脉吻合口出血者死亡。结论ＤｅＢａｋｅｙ Ⅱ型病人,当冠状动脉开口直接缝合于带瓣管道上有困难时,采用Ｃａｂｒｏｌ手术有其优点－采用１根８ｍｍ直     

胸部降主动脉瘤的外科治疗

１９９０年４月至１９９５年１２月我们共收治胸部降主动脉瘤病人４８例，现报告如下：临床资料本组４８例病人中男４１例，女７例。年龄２１～６３岁，平均（３９．０±２．３）岁。临床诊断ＤｅＢａｋｅｙＩＩ型夹层动脉瘤３１例，单纯降主动脉瘤１０例，主动脉峡部瘤４...     

腔内隔绝术治疗主动脉瘤的初步经验

目的 探讨腔内隔绝术(EVAR)治疗主动脉瘤的方法、手术适应证,并评价其治疗效果.方法 回顾性分析2003年3月～2008年3月行EVAR术治疗65例主动脉瘤患者的临床资料;其中主动脉夹层动脉瘤33例(stanfnrd B),胸主动脉瘤4例,肾下腹主动脉瘤28例.结果 65例动脉瘤EVAR手术均获得成功,33例夹层动脉瘤的假腔在术后造影立刻消失,28例腹主动脉瘤及4例胸主动脉瘤瘤体成功隔绝.随访3～24个月,1例患者术后2个月死亡,其余患者未发现支架移位或内漏.结论 动脉瘤的EVAR术治疗具有创伤小、操作可行及效果确切等优点,早期疗效满意,但远期疗效有待于临床进一步观察.严格选择手术适应证是手术成功的关键.     

A case of Marfan's syndrome that required emergency Bentall's operation due to acute dissecting aortic aneurysm (DeBakey type II) following surgery of abdominal aortic aneurysm]

Graft replacement was performed in a 29-year-old man for an abdominal aortic aneurysm associated with Marfan's syndrome. Since the dissecting aortic aneurysm (DeBakey type II) accompanied by disruption of the right coronary artery developed 74 days after operation, the emergency Bentall's operation was successfully carried out with bypassing of the right coronary artery using a saphenous vein graft. Fifteen Japanese cases operated on for abdominal aortic aneurysm associated with Marfan's syndrome are reviewed, and the problems concerning surgery of abdominal aortic aneurysm and Bentall's operation are discussed.     

升主动脉瘤的外科治疗

目的探讨升主动脉瘤治疗经验。方法Marfan’s综合征12例,其中6例合并二尖瓣关闭不全。升主动脉夹层动脉瘤伴主动脉瓣关闭不全6例,升主动脉瘤合并主动脉瓣、二尖瓣关闭不全2例,单纯升主动脉瘤5例,行Bentall手术12例,Cabrol手术3例,Wheat手术5例;单纯升主动脉替换术5例。结果全组无手术死亡。结论Bentall手术是外科治疗升主动脉瘤的主要术式。早期诊断、早期手术是改善升主动脉瘤患者疗效的关键。     

Emergency operation in impending rupture of aortic arch dissecting aneurysm--a case report of dissecting aortic aneurysm with adhesion to the lung after lobectomy

Successful surgical treatment of impending rupture of a aortic arch dissecting aneurysm in a 59-year-old man was reported. The aneurysm was tightly adhered to the lung, because he had a previous history of lobectomy. In this case, the permanent aortic bypass with permanent aortic clamp as a means of exclusion procedure of the aortic aneurysm was effective. The postoperative course was uneventful. In the emergency operation for aortic arch aneurysm, operative procedure should be selected by operative findings and risk.     

Aneurysm of a jejunal branch of the superior mesenteric artery in a patient with Marfan's syndrome

A case of post-traumatic aneurysm of a jejunal branch of the superior mesenteric artery in a patient with Marfan's syndrome is reported. Ascending aortic involvement is well known in Marfan's syndrome but no association with visceral artery aneurysms has been previously described. The blunt abdominal trauma preceding the detection of the aneurysm may have been the precipitating cause in a predisposed patient. Because of the high risk of rupture, aneurysms of the superior mesenteric artery branches should be treated. Excision or ligation without restoring continuity are the most common surgical procedures; endovascular embolization is an alternative option especially in high risk patients.     

Results of Aortic Surgery in Patients with Marfan Syndrome

Purpose We reviewed the outcome of aortic operations in patients with Marfan syndrome to evaluate the immediate and long-term results of surgical treatment.Methods Between January 1985 and June 2002, 22 patients with Marfan syndrome underwent surgical treatment for aortic diseases at our hospital. Eight patients had Stanford type A aortic dissection and ten patients had aortic root aneurysm with aortic regurgitation. We performed aortic root replacement in 21 patients. Subsequent aortic operations were done in 11 patients, 6 of whom required a third operation. Five patients underwent repeat surgery of the previously operated aortic segment. A collective a total of 42 aortic operations were performed in the 22 patients. Seven patients underwent total aortic replacement.Results The in-hospital mortality rate was 4.5%, and there were three late deaths: two caused by rupture of the dissected aorta, 17 months and 24 months after the last surgical intervention, respectively, and one caused by heart failure 27 months after a total aortic replacement. The overall actuarial survival was 90.2% at 5 years and 74.4% at 10 years.Conclusions Surgical treatment of patients with Marfan syndrome can be accomplished with low mortality; however, new aortic lesions should be promptly explored, and appropriately timed surgical treatment can substantially improve the prognosis of patients with Marfan syndrome.     

Dissecting aortic aneurysm in siblings without Marfan's syndrome

The occurrence of dissecting aortic aneurysm in 2 or more family members is rare. We reported two cases of dissecting aortic aneurysm in one family. Case 1. Brother. A 49-year-old male, was diagnosed to have acute dissecting aortic aneurysm (DeBakey type I) with mild aortic regurgitation. He was operated on by valvuloplasty and closure of the false lumen, and is alive and well at the present time. Case 2. Sister. A 60-year-old female, was diagnosed to have chronic dissecting aortic aneurysm (DeBakey type II). She underwent replacement of the ascending aorta with a Dacron graft. She is alive and well. Neither of these 2 patients nor other family member had any features of the Marfan's syndrome. Histological examination of 2 cases showed the degeneration of smooth muscle in the media. Among their family, mother died of unidentified heart disease.     

Consequences of incomplete repair of acute type A aortic dissection

During emergency repair of acute Stanford type A aortic dissections, surgical compromises in the form of incomplete arch replacement are made due to the unstable condition of the patient and safety issues of the performing team. We report a case of delayed reoperation after previous incomplete surgery for acute type A aortic dissection in a young patient with Marfan's syndrome. He presented again with repetitive chest pain five years after initial surgical treatment. Extensive aneurysmal dilatation of the aorta and remaining dissection led to the decision to replace the ascending aorta and the aortic arch. After a good progress during the first days after surgery, the patient died due to a ruptured thoraco-abdominal aneurysm on the fifth postoperative day. Extensive surgical reconstruction including aortic arch replacement should be considered in patients with Marfan's syndrome who present with aortic dissections type A to avoid unnecessary reoperations and their complications.     

Total aortic replacement for chronic aortic dissection occurring in patients with and without Marfan's syndrome.

Total aortic replacement including aortic valve was performed successfully in the two patients in whom this method of treatment was utilized to correct a chronic dissecting aortic aneurysm. Both patients had moderately severe aortic insufficiency producing increasing heart strain and progressive enlargement of the false lumen of aortic dissection involving the entire aorta despite ideal blood pressure control. In addition, one patient had Marfan's syndrome. The surgical treatment for both patients was performed in two stages. At the first operation, cardiopulmonary bypass, profound hypothermia, and circulatory arrest were employed while the aortic valve and the ascending and transverse aortic arch were replaced and the coronary and brachiocephalic vessels were reattached to the composite valve-graft used for replacement. At the second operation, the entire descending thoracic and abdominal aortic segments were replaced with a graft and the intercostal, lumbar, and visceral arteries reattached thereto. Left vocal cord paralysis occurred in both patients and transient mild paraparesis occurred in only one. Both patients are alive and well, one at 13 months and one at 6 weeks. This experience suggests an additional treatment modality for selected patients with complications of chronic aortic dissection.     

A型主动脉夹层动脉瘤的外科治疗

目的　总结 1996年 1月至 2 0 0 2年 8月收治的 34例 A型主动脉夹层动脉瘤的外科治疗经验。　方法　应用 Bentall手术 19例 ,升主动脉人工血管置换术 7例 ,升主动脉人工血管置换加主动脉瓣成形术 (Trusler's法 )5例 ,分别行升主动脉人工血管置换及主动脉瓣置换术 (Wheat术 ) 2例 ,升主动脉、主动脉弓人工血管置换术 1例。结果　手术死亡 6例 ,死亡率 17.6 %。其中慢性主动脉夹层动脉瘤死亡 3例 ,急性夹层动脉瘤死亡 3例。随访 2 0例 ,随访率 71.4 %。随访时间 2～ 4 6个月 ,平均 2 4 .7个月 ,1例术后 3个月猝死 (原因不明 ) ,1例术后 6个月死于心内膜炎。18例存活患者情况良好。　结论　应根据夹层动脉瘤的部位及范围采用不同的手术方式 ,保留主动脉瓣的升主动脉人工血管置换术治疗该病效果较好 ,准确可靠的吻合技术、保留瘤壁的完整性 ,将使手术更为安全。