29例主动脉夹层动脉瘤治疗分析

目的总结29例主动脉夹层动脉瘤外科治疗经验。方法29例患者中,DeBakey分型,Ⅰ型16例,Ⅱ型4例,Ⅲ型9例。21例手术治疗,其中6例行Bentall术,2例行Wheat术,5例行升主动脉置换(同时主动脉瓣成形4例),1例行胸主动脉置换,7例置入支撑型人工血管;8例不接受手术。结果手术死亡2例,其中1例为胸主动脉置换术后并发吻合口出血死亡,1例为支撑型人工血管置入后内漏瘤破裂猝死。非手术8例中,4例死亡,4例转慢性化趋稳定出院。结论对主动脉夹层动脉瘤应积极手术,Ⅰ、Ⅱ型可急诊手术,Ⅲ型可置入支撑型人工血管。早诊断,快速急诊手术是抢救成功的关键。

Primary experience in therapy of aortic dissecting aneurysm in 29 patients

Objective Summarize the primary experience by reviewing the cases of aortic dissecting aneurysm in 29 patients. Methods According to the typing of DeBakey, 16 were in type I, 4 in type II, 9 in type III. Twenty-one patients underwent surgical treatment, 6 had Bentall operation, 2 Wheat operation, 5 ascending aorta replacement, 1 aorta thoracica replacement operation, 7 had supportive vascular prosthesis implanted, 4 of whom had combined aortic valve plasty. Eight patients refused operation. Results Two patients died in operation group, one suffering from fatal stoma hemorrhage,another from rupture of vascular prosthesis. Among of nonoperative eight patients, 4 died, the other 4 discharged safely. Conclusion Aortic dissecting aneurysm should be managed aggresively. Both type I and type II should be operated urgently, type III may be treated by inserting supportive vascular prosthesis. Early diagnose and emergent operation is essencial to rescue patients.