升主动脉瘤的外科治疗

目的：总结14例升主动脉瘤外科治疗经验。方法：马凡综合征9例，其中7例并发夹层分离，升主动脉瘤伴主动脉瓣关闭不全3例，急性夹层动脉瘤伴主动脉瓣关闭不全1例，单纯升主动脉瘤1例。行钮扣式Bentall手术11例（1例合并MVR），其中升主动脉瘤破裂及术前心衰不能控制急症手术各2例，Wheat手术2例，其中1例因急性夹层动脉瘤急症手术；单纯升主动脉替换1例。结果：早期死亡3例，11例平均随访32个月，心功能明显改善，晚期因颅内出血死亡1例，再发生动脉弓，降主动脉夹层动脉瘤1例。结论：钮扣式Bentall手术是升主动脉瘤标准术式，急症手术死亡率高，早期诊断，早期手术是改善升主动脉瘤预后的关键。

Surgical treatment of ascending aortic aneurysm

Objective To review the clinical experience in surgical treatment of ascending aortic aneurysm. Methods Between December 1994 and April 2001, a consecutive total of 14 patients (9 male , 5 female, aged 16-55 years ) underwent operations for disease of the ascending aorta: aneurismal dilatation with moderate-to-sever aortic regurgitation in 12 patients (3 of them with mild to moderate mitral regurgitation, 1 of them with moderate to sever mitral regurgitation), acute dissecting aneurysm with aortic regurgitation in 1, aneurysm without aortic regurgitation in 1. Acute dissections occurred in 6 of 9 patients with Marfen syndrome. 14 patients underwent surgery including button Bentall's operation in 11 (1 combined with MVR), Wheat's operation in 2, resection of ascending aortic aneurysm with vascular prosthesis grafting in 1. Two patients with rupture of dissecting aneurysm, two ones with cardiogenic shock and one patient with acute dissecting aneurysm underwent emergency operation. Results There were three early postoperative death in patients after emergency operation. During a mean follow up of 32 months in 11 patients, cardiac function were improved in all patients after operation, one died of intracranial blooding, one suffered from recurrent dissection at the aortic arch and descending aorta. Conclusion Button Bentall's operation is the standard manner for treating ascending aortic aneurysm. The mortality after emergency operation is high. Earlier diagnosis and prompt operation before development of preoperative complications are essential to improve surgical results.