升主动脉瘤合并主动脉瓣关闭不全的外科治疗

目的：回顾性总结自１９９１年１２月至１９９９年５月期间，３３例升主动脉瘤伴主动脉瓣关闭不全外科治疗的经验。方法：３３例升主动脉瘤中，１例为真性动脉瘤。３２例为夹层动脉瘤。夹层动脉瘤按ＤｅＢａｋｅｙ分型法，Ｉ型８例，ＩＩ型２４例，均伴主动脉关闭不全，均行Ｂｅｎｔａｌｌ手术，１０例合并二、三尖瓣关闭不全，做二、三尖瓣整形手术。１例合并冠心病，做内乳动脉与前降支搭桥术，结果：手术死亡率为６．０％（２／３３），２例分别死于感染性心内膜为和吻合不可控制性渗血，２例有严重脑部并发症，随访时间１～５５个月，远期死亡２例，均系错迷窒息死亡，其余２９例心功能明显改善，眩动脉瘤无复发。结论：（１）升主动脉瘤合并主动脉瓣关闭不全行Ｂｅｎｔａｌｌ手术，采用良好的心肌保护方法，注意吻合技术防止出血，可以取得良好的手术效果。（２）对Ｄ

Surgical treatment of ascending aortic aneurysm complicated with aortic regurgitation

Objective Thirty three cases of ascending aortic aneurysm (AAA) complicated with aortic regurgitation (AR) for surgical treatment were analysed retrospectively. Methods All the cases with AR were dissecting aneurysm and divided into DeBakey type I , 8; type Ⅱ, 24 except one, and corrected by Bentall Operation. Results The operation mortality was 6.0％ (2/33), due to postoperative endocarditis and uncontrolled bleeding. Severe cerebral damage occurred in two of them who died 2 months later, while the rest stayed in good cardiac function and no recurrence of aneurysm after 1 ～ 55 months follow-up. Conclusion AAA complicated with AR can be corrected successfully by Bentall Operation under good myocardial protection and fine anastomosis technique; canulation in right subclavian artery should be selected in AAA of DeBakey type I in order to avoid obstruct the true lumen by dissection and change into selective cerebral perfusion in case; aneurysm can be resected completely by hypothennia arrest and retrograde perfusion via superrior vena cava. Left internal mammary artery (LIMA) is first selected in case of undergoing CABG together.