主动脉夹层的外科治疗

目的总结84例主动脉夹层患者的外科治疗经验，探讨手术技巧和围术期处理，以提高手术疗效。方法50例Stanford A型主动脉夹层患者在体外循环下（11例采用深低温停循环技术）行Bentall手术或Cabrol手术24例，升主动脉人工血管置换术8例，Trusler手术5例，Wheat手术5例，升主动脉＋主动脉全弓或半弓人工血管置换术8例；34例Stanford B型主动脉夹层采用带膜支架主动脉腔内修复术治疗。结果住院死亡11例，死亡率13．1％。术中死亡3例，其中1例升主动脉＋次全弓人工血管置换患者因术中主动脉开放后主动脉根部大出血无法止血；1例升主动脉部分切除＋人工血管置换患者心脏无法复跳；1例升主动脉＋半弓血管置换患者因降主动脉夹层破裂死亡。术后早期死亡8例，其中死于低心排血量综合征2例，肺部感染2例，肾功能衰竭2例，呼吸衰竭1例，永久性神经系统损害1例。术后发生并发症16例。随访62例（84．9％，62／73），随访时间3个月～10年。随访期间死亡2例，其中1例死于心内膜炎，1例猝死（原因不明）。结论快速准确地诊断、个体化的手术方案和精确的手术技术是主动脉夹层手术成功的关键。

Surgical Treatment of Aortic Dissection

Objective To summarize the experience of surgical treatment for 84 patients with aortic dissection, investigate the surgical technique and perioperative treatment, and to improve surgical results. Methods The operations were performed in 50 patients with aortic dissection of Stanford A, Bentall or Cabrol operations were performed in 24 patients, graft replacement of ascending aorta in 8 patients, Trusler operation in 5 patients, Wheat operation in 5 patients, operation of ascending aorta and aortic arch in 8 patients. Stent-graft were used in 34 patients with aortic dissection of Stanford 13. Results There were 11 hospital death,the hospital mortality was 13.1 %. There were 3 operative deaths. One patient with ascending aortic and hemiarch grafting died of aortic root bleeding;one patient with replacement of ascending aorta died of failure to restart heart beating; one patient with ascending aortic and hemiarch grafting died of rapture of aortic dissection. There were 8 post-operative deaths, including low cardiac output syndrome in 2 patients, lung infection in 2 patients, renal failure in 2 patients, respiratory failure in 1 patient and permanent mental anomaly in 1 patient. The complications were occurred in 16 patients. The follow-up period was 3 months to 10 years, and carried out in 62 patients（84. 9%,62/73）. One died of endocarditis, another one died of sudden death. Conclusion The surgical treatment of aortic dissection could be carried out safely based on the accurate diagnosis, specific surgical strategy and fine surgical technique.