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目的探讨主动脉夹层瘤的外科手术治疗效果及体外灌注方法。方法选择2001~2005年手术治疗的7例主动脉夹层患者,其中急性夹层4例,慢性夹层3例;DeBakey Ⅰ型主动脉夹层瘤4例中行升主动脉置换及全弓替换2例,行升主动脉置换及全弓替换加支架1例,行Bentall手术同期行半弓置换1例。同期行冠状动脉搭桥2例。4例采用深低温停循环(DHCA)、左锁骨下动脉灌注和上腔静脉逆灌(RCP)。DeBakey Ⅱ型主动脉夹层瘤2例,单纯行升主动脉置换,DeBakey Ⅲ型1例,非体外循环下行降主动脉置换。结果7例均痊愈出院,无手术和住院死亡病例。电话及门诊随访6~12个月,心功能Ⅰ级6例,Ⅱ级1例。结论采用合适的手术治疗方法和体外循环技术治疗主动脉夹层瘤可以取得良好的效果。
Objective To investigate the surgical treatment of aortic dissection and its in vitro perfusion method. Methods Seven patients with aortic dissection between 2001 and 2005 were selected, including 4 acute dissections and 3 chronic dissections. In 4 patients with DeBakey type Ⅰ aortic dissection, ascending aortic replacement and total arch replacement were performed in 2 patients. Aortic replacement and total bow replacement plus stent in 1 case, Bentall line operation in the same period half bow replacement in 1 case. Coronary artery bypass grafting in 2 cases. Four patients underwent deep hypothermic circulatory arrest (DHCA), left subclavian artery perfusion and superior vena cava reverse irrigation (RCP). DeBakey type Ⅱ aortic dissection in 2 cases, simple ascending aorta replacement, DeBakey Ⅲ type in 1 case, descending aorta replacement without cardiopulmonary bypass. Results 7 cases were cured, no surgery and in-hospital deaths. Telephone and outpatient follow-up 6 to 12 months, 6 cases of grade Ⅰ heart function, Ⅱ grade in 1 case. Conclusion The appropriate surgical treatment and cardiopulmonary bypass techniques for the treatment of aortic dissection can achieve good results.