升主动脉和弓部动脉瘤的外科治疗

目的：总结升主动脉和弓部动脉瘤手术治疗经验，以期进一步提高手术疗效。方法：自2000年7月至2002年5月应用深低温停循环（DHCA）和上腔静脉逆行脑灌注（RCP）技术手术治疗升主动脉和弓部动脉瘤20例，其中急症手术5例。施行全弓置换术2例，全弓置换和象鼻手术3例，半弓置换术15例。同期行Bentall手术8例，升主动脉置换术或同时行主动脉瓣置换术12例，冠状动脉旁路移植术1例。结果：术后早期死亡1例，短时间浅昏迷1例，呼吸功能不全2例，肾功能不全2例，无晚期死亡。结论：DHCA和RCP技术是手术治疗升主动脉和弓部瘤的安全、有效方法，急性A型夹层动脉瘤的手术方式取决于内膜破裂口的位置；正确掌握DHCA和RCP技术，手术方式和手术技术、围术期处理是提高手术疗效的关键因素。

Surgical treatment of ascending aorta and aortic arch aneurysm

Objective To summarize the surgical treatment of ascending aorta and aortic arch aneurysm for further improvement of the surgical result. Methods Twenty patients with ascending aorta and aortic arch aneurysm were operated on using deep hypothermic circulatory arrest (DHCA) and retrograde cerebral perfusion (RCP) from Jul 2000 to May 2002. Urgent operation was done in 5 cases. Total aortic arch replacement was performed in 2 cases, total aortic arch replacement and elephant truck procedure in 3 cases, and hemiarch replacement in 15 cases. Concomitant procedures included Bentall in 8 cases, ascending aorta replacement or with aortic valve replacement in 12 cases,coronary artery bypass grafting (CABG) in 1 cases. Results Early operative death occurred in 1 cases. Complications were 1 superficial coma, 2 respiratory insufficiency, and 2 renal insufficiency. There was no late death. Conclusions DHCA and RCP is a safe and effective method for the surgery of ascending aorta and aortic arch aneurysm. The surgical types depend on the location of intimal tear in acute type A dissection. Correct using of DHCA and RCP, optimal surgical technique and procedures, and perioperative management are the key factors to improve surgical outcome.