A型胸主动脉夹层动脉瘤的外科治疗

目的总结对主动脉夹层动脉瘤病人的外科治疗经验。方法StandfordA型夹层动脉瘤病人26例,术前经超声心动图(UCG)、胸部增强CT或MRI检查明确诊断。采用中度低温体外循环18例,8例采用深低温停循环法(DHCA)合并经上腔静脉逆灌注(RCP),行Bentall手术23例,其中合并右冠搭桥和半弓替换各1例,Wheat手术2例,升主动脉人工血管置换1例。结果手术死亡2例,死亡率7.7%。1例术后2个月死于抗凝过量致颅内出血,3例远端夹层复发。结论术前快速明确诊断,正确掌握手术指征和手术技术,术中良好的脑保护和心肌保护是手术治疗夹层动脉瘤的关键。DHCA和RCP对A型夹层是安全有效的方法,A型夹层的手术方式应依据病因及内膜破口位置决定。

Surgical treatment of type-A aortic dissecting aneurysm

Objective To summarize the surgical experience of treating type-A aortic dissecting aneurysm.Methods From December 1994 to Feburary 2005,26 patients with type-A aortic dissecting aneurysm underwent surgical treatment.They were diagnosed with UCG and spiral CT or MRI before the operation.The operations were performed by using moderately hypothermic extracorporeal circulation in 18 cases,and deeply hypothemic circulatory arrest(DHCA)combined with retrograde superior vena cava perfusion(RCP)in 8 cases.The procedures included Bentall operation in 23 cases,one of whom was combined with right coronary bypass surgery,another one was combined with hemi-arch grafting,Wheat operation in 2 cases,artificial vascular replacement of ascending aortic in one case.Results There was 2 cases of intraoperative death with a mortality rate of 7.7%.One case died of intracranial hemorrhage in 2 months after the operation.Three cases relapsed into distal dissecting.Conclusion The key factors for success in the surgery of aortic dissceting are rapid diagnosis,proper surgical indication,surgical technique,introperative brain protections and myocardial protections.DHCA with RCA is safe and effective for type-A aortic dissection aneurysm.Procedures chosen must depend on the cause of the disease and the location of intimal tear.