升主动脉根部瘤的外科治疗

目的总结升主动脉根部瘤的外科治疗经验。方法101例升主动脉根部瘤患者（年龄14～72岁，平均年龄42．7岁）的主要病因为马方综合征（Marfan syndrome，58例），主动脉瓣环扩张症（34例），主动脉瓣二叶瓣畸形（5例），大动脉炎（4例）；术前有主动脉瓣关闭不全96例，主动脉瓣狭窄4例，术前合并有A型夹层26例，急性左心衰竭（5例）。手术类型：Wheat手术4例，传统或改良Cabrol手术13例，David手术1例，Bentall手术83例。同期行主动脉半弓置换术或降主动脉腔内支架植入术16例，全弓置换术或降主动脉腔内支架植入术4例，二尖瓣置换术或成形术14例，冠状动脉旁路移植术8例。结果全组手术死亡率为6．9％（7／101），2000年后降至3．6％（3／83）；术后主要并发症为低心排血量10例，呼吸功能不全9例，肾功能不全9例。术后随访94例，随访期间死亡1例，5例马方综合征患者术后出现B型夹层。结论Bentall手术是治疗升主动脉根部瘤的首选手术方法，术前左心功能及手术技术是影响手术效果的关键因素。

Surgical Treatment of Ascending Aortic Root Aneurysms

Objective To summarize the experiences in surgical treatment of ascending aortic root aneurysms.(Methods One) hundred and one patients(age ranging from 14 to 72 years,mean 42.7 years) with ascending aortic root aneurysms were diagnosed as having Marfan syndrome(58 cases),annuloaortic ectasia (34 cases),bicuspid aortic valve(5 cases),aorto-arteritis(4 cases) combined with aortic valve incompetence(96 cases) and aortic valve stenosis(4 cases),preoperatively with type A dissection(26 cases) and acute left heart failure(5 cases).Our operations consisted of 4 Wheat procedures,13 Cabrol or modified Cabrol procedures,1 David and 83 Bentall procedures.Concomitant operations included hemi-arch replacement or descending aorta intraluminal stent grafting(16 cases),total arch replacement or descending aorta intraluminal stent grafting(4 cases),mitral valve replacement or anuloplasty(14 cases) and coronary artery bypass grafting(CABG,8 cases).Results The overall mortality was 6.9%(7/101),and decreased to 3.6%(3/83) after the year 2000.Main postoperative complications were low cardiac output(10 cases),respiratory insufficiency(9 cases),and renal inadequacy(9 cases).Follow-up was completed in 94 patients.During the period of follow-up,one patient died and 5 patients with Marfan syndrome suffered with type B dissection.Conclusion Bentall procedure is the method of choice for ascending aortic root aneurysms.Preoperative left heart function and surgical techniques give the crucial impact on the outcome of surgery.