主动脉瘤的外科综合治疗

目的总结2005年1月至2011年1月39例各类主动脉瘤行人工血管移植、介入腔内隔绝、＂杂交手术＂等外科综合治疗的经验,探讨手术方法的选择和手术新技术的应用。方法单纯Bentall手术3例,单纯升主动脉置换1例,David手术1例,Wheat手术1例,Bentall及右半弓人工血管置换术2例,＂杂交手术＂5例（Ⅰ型杂交：Ben-tall手术＋全弓置换＋介入腔内隔绝降主动脉1例;Ⅱ型杂交：主干与分支动脉人工血管转流＋介入腔内隔绝降主动脉及左半弓4例）,降主动脉人工血管置换术4例,降主动脉及左半弓人工血管置换术2例,腹主动脉分叉人工血管移植并与髂动脉吻合术3例,腔内覆膜支架介入隔绝降主动脉和腹主动脉夹层动脉瘤17例。结果住院死亡3例：1例Bentall及右半弓人工血管置换术中主动脉根部出血无法止血,1例Bentall术后死于多脏器功能衰竭,1例腹主动脉腔内隔绝术后下消化道出血死亡。腔内覆膜支架介入隔绝实时操作成功率（即夹层裂口完全封闭,恢复真腔血流,动脉假腔不再显影）100%。35例随访3~82个月,3个月内无死亡;1例介入腔内隔绝降主动脉术后38个月再发弓部夹层动脉瘤死亡。结论根据病变部位、程度,采用包括人工血管移植、介入腔内隔绝、＂杂交手术＂等个体化的手术方案进行综合外科治疗可以明显提高动脉瘤的救治率。

Comprehensive Surgical Treatment of Aortic Aneurysm

Objective To summarize the experience of comprehensive surgical treatment of 39 patients with aortic aneurysm who underwent endovascular stent grafts,endovascular occlusion,＂hybrid operation＂,and other surgical techniques from January 2005 to January 2011,and to investigate the choice of surgical methods and the application of new technologies.Methods Bentall operation was performed in 3 patients,ascending aortic replacement in 1 patient,David operation in 1 patient,Wheat operation in 1 patient,Bentall and replacement of the right half aortic arch in 2 patients,＂Hybrid operation＂ in 5 patients（TypeⅠ：Bentall combined with total aortic arch replacement and interventional endovascular stent grafting into descending aorta in 1 patient;TypeⅡ：the trunk or branch artery bypass grafting combined with interventional endovascular stent grafting into descending aorta and left half aortic arch in 4 patients）,graft replacement of descending aorta in 4 patients,graft replacement of descending aorta and left half aortic arch in 2 patients,abdominal aortic bifurcation grafting and anastomosis with the iliac artery in 3 patients,and interventional endovascular stent grafting into descending aorta and abdominal aortic dissection in 17 patients.Results There were 3 hospital death cases：1 died of aortic root bleeding during Bentall operation and right half aortic arch grafting,1 died of multiple organ failure after Bentall operation,and 1 died of lower gastrointestinal bleeding after endovascular exclusion of abdominal aortic aneurysm.The interventional endovascular stent grafts were all manipulated successfully（100%）.The gaps in the dissection were completely closed,the bloodstream recovered in the true lumens,and the false lumens were no longer developing.Thirty-five patients were followed up for 3 to 82 months.No death occurred during the initial 3 months.One patient died of dissecting aortic aneurysm recurrence 38 months after descending aorta endovascular intervention.Conclusion According to the region and extent of lesion,comprehensive surgical techniques,including artificial vascular grafts,endovascular intervention,and ＂Hybrid operation＂,can significantly improve the treatment of aortic aneurysm.