单纯主动脉缩窄的外科治疗

目的总结单纯主动脉缩窄外科治疗的经验,评价手术时机和方法。方法1990年6月至2005年8月,手术治疗单纯主动脉缩窄17例,其中行主动脉缩窄切除对端吻合术5例,人工血管移植术3例,补片成形术7例,Vosschulte成形术1例,左锁骨下动脉-降主动脉人工血管转流术1例。结果术毕上下肢平均动脉压的压差<10mmHg者13例,上肢平均动脉压仍高于下肢10～30mmHg者4例。术后早期高血压者14例。随访5个月至10年,下肢血压高于上肢者13例,无明显差异者3例,下肢血压仍明显低于上肢者1例,仍有高血压者5例;成形部位动脉瘤样扩张1例,再缩窄1例。结论早期诊断、早期治疗是提高生存率和减少术后高血压的关键。手术方法应根据患者年龄、病理特征和术者经验选择。

Surgical treatment for isolated coarctation of aorta

Objective To summarize the experience of surgical treatment for isolated coarctation of aorta, assess the occasion and method of operations. Methods From June 1990 to August 2005, 17 patients for isolated coarctation of aorta have undergone corrective operation. These are the surgical techniques adopted stenosis resection with end-to-end anastomosis in 5 cases, resection with artificial graft replacement in 3 cases, aortoplasty with patch graft in 7 cases. Vosschulte aortoplasty in 1 case and left subclavian artery-descending aortic bypass graft in 1 case. Results After the operations, the gradients of mean artery pressure between the upper and lower limbs less than 10 mm Hg were in 13 cases. Mean artery pressure of upper limbs more 10-30 mm Hg than of lower limbs were in 4 cases. Early postoperative hypertention appeared in 14 cases. Following-up for 5 months to 10 years,it showed artery pressure of upper limbs more than of lower limbs in 13 cases, no significant difference between the upper and lower limbs in 3 cases, artery pressure of lower limbs less than of upper limbs in 1 case. Later hypertension appeared in 5 cases, aneurysmal dilatation happened in 1 case and restenosis in 1 case. Conclusion Early diagnosis and surgical correction is key to enhance survival and reduce postoperative hypertension. The selection of methods for surgical correction should take age, pathology feature and surgeons' experience into account.