胸主动脉瘤及主动脉夹层外科治疗进展

胸主动脉瘤及主动脉夹层病情凶险，死亡率和病残率均很高。近几年在保留和不保留主动脉瓣的主动脉根重建术治疗升主动脉瘤，弓部主动脉瘤切除与脑保护，胸主动脉瘤或胸腹主动脉瘤切除与脊髓保护，以及主动脉腔内支架移植术等方面取得了较大的进展。手术死亡率已从31．4％下降至3．3％－4．8％。胸主动脉瘤，特别是主动脉夹层系一全身性主动脉病变，近年来手术疗效有所改善，但远期复发率和再手术率仍较高。主动脉内支架移植与外科手术结合应用，对复杂的伴有降主动脉病变的A型主动脉夹层治疗，可能是一种安全而有效的方法。

The advance of surgical management of thoracic aortic aneurysm and aortic dissection

Thoracic aortic aneurysm and aortic dissection are a serious disease, the mortality and morbidity were very high. In recent years the management of ascending aortic aneurysm using the reconstruction of aortic root with or without valve preserving, resection of aortic arch aneurysm and brain protection, resection of thoracic aneurysm or thoracic abdominal aortic aneurysm with spinal cord protection, and the progress of aortic endoluminal stent grafting etc were made more significant progress. The mortality decreased from 31.4% to 3.3%-4.8%. Thoracic aortic aneurysm, especially aortic dissection is a systemic aortic lesion, the surgical managements have been made better results in recent years, but the long term recurrence rate and reoperative rate were still high. The application of aortic endoluminal stent grafting combined with surgical repair in type A complex aortic dissection would be a safe and effective method.