论文部分内容阅读
目的介绍外科与腔内隔绝术治疗主动脉瘤的体会。方法手术与腔内隔绝术治疗主动脉瘤40例,手术治疗30例,Bentall术9例,Bentall+部分弓置换3例,主动脉瘤切除人工血管置换6例,主动脉瘤切除补片修补4例,升主动脉+部分弓置换、主动脉瓣二尖瓣置换+升主动脉折叠缝合术各2例,主动脉瓣置换+升主动脉置换、主动脉瓣置换升主动脉折叠缝合术、主动脉瘤切除直接缝合、主动脉瘤切除人工血管置换+左全肺切除术各1例。腔内隔绝术治疗假性胸降主动脉瘤1例、假性腹主动脉瘤1例、夹层主动脉瘤ⅢA型1例、ⅢB型7例,经股动脉切口植入32~38mm覆膜支架。结果手术后因低心排出量综合征和出血各死亡1例,死亡率6.7%,无截瘫、偏瘫和感染。覆膜支架腔内隔绝术后1~2周内低热8例,无大出血、内漏和死亡。生存38例,随访1个月~5年,无死亡和远期并发症。结论升弓部主动脉瘤的手术治疗效果满意,覆膜支架腔内隔绝治疗DeBakeyⅢ型夹层主动脉瘤创伤小、并发症少、恢复快。
Objective To introduce the surgical and endovascular exclusion of the treatment of aortic aneurysm experience. [Methods] 40 cases of aortic aneurysm were treated by surgery and endovascular exclusion. Thirteen cases were treated by surgery, 9 cases were treated by Bentall procedure, 3 cases were treated by Bentall + partial arch replacement, 6 cases were treated by aortic aneurysm removal, 4 cases were treated by aortic aneurysm resection and patch repair , Ascending aorta + partial arch replacement, aortic valve mitral valve replacement + ascending aortic fold suture in 2 cases, aortic valve replacement + ascending aortic replacement, aortic valve replacement ascending aortic fold suture, the aorta Tumor resection direct suture, aortic aneurysm resection of artificial vascular replacement + left pneumonectomy in 1 case. Endovascular graft exclusion in the treatment of false thoracic aortic aneurysm in 1 case, 1 case of pseudo-abdominal aortic aneurysm, 1 case of dissecting aortic aneurysm type Ⅲ A, Ⅲ B in 7 cases, the femoral artery incision 32 ~ 38mm stent graft . Results After the operation due to low cardiac output syndrome and bleeding in 1 case of death, mortality 6.7%, no paraplegia, hemiplegia and infection. Endovascular stent-graft exclusion of 1 to 2 weeks after the fever in 8 cases, no major bleeding, leakage and death. Survival in 38 cases, followed up for 1 month to 5 years, no death and long-term complications. Conclusions The surgical treatment of aortic aneurysm in lumbar arch is satisfactory. The treatment of DeBakey Ⅲ type dissecting aortic aneurysm with stent-graft is less invasive and has fewer complications and faster recovery.