摘要目的 探讨胸主动脉夹层患者外科治疗的方法和效果.方法 回顾性分析2004年12月至2006年12月接受外科治疗的51例主动脉夹层患者的临床资料.其中男性35例,女性16例;年龄18～83岁,平均(55.7±10.8)岁.按DeBakey法分类,Ⅰ型27例,术中采用深低温停循环+顺行脑灌注法行全弓置换术,主动脉弓远端放置带膜支架.Ⅱ型5例,行Bentall手术3例,Wheat手术1例,单纯升主动脉置换术1例.Ⅲ型19例,均采用直视下带支架人工血管植入术.结果 Ⅰ型心肺转流时间为250～290 min,平均(274±53)min,停循环时间为40～59min,平均(53±14)min.Ⅱ型心肺转流时间为130～159 min,平均(146±43)min,心肌阻断时间为60～79 min,平均(66±15)min.Ⅲ型心肺转流时间为240～280 min,平均(260±28)min,停循环时间为20～27 min,平均(24±3)min.全组术中出血量(500±250)ml,重症监护治疗时间(5.0±1.5)d,住院时间(15.0±2.5)d.围手术期死亡3例,2例发生脑血管意外.术后全组患者随访2～21个月,平均11个月.1例术后发生降主动脉扩张.结论 对胸主动脉夹层患者,采用个体化治疗方法,可以获得良好的治疗效果.

abstractsObjective To summarize the clinical experience about surgical treatment of aortic dissection.Methods The clinical data of 51 patients with aortic dissection admitted from December 2004 to December 2006 were analyzed retrospectively.There were 35 male and 16 female patients with a mean age of 55.7 years(ranged from 18 to 83 years old).Twenty-seven patients of type Ⅰ was performed under deep hypothermic circulatory arrest and selected cerebral perfusion with stent-graft which was implanted into the descending aorta through aorta arch.Five patients of typeⅡwas performed including Bentall operation in 3 patients,Wheat operation in 1 patient,ascending aorta replacement in 1 patient.Nineteen patients of type Ⅲwas performed with stent-graft which was implanted into the descending aorta through aorta.arch under deep hypothermic circulatory arrest.Results The time of cardiopulmonary bypass(CPB)in type Ⅰ patients was 250 to 290 min with an average of(274±53)min,and the arrest time was 40 to 59 min with an average of(53±14)min.CPB time of typeⅡ patients was 130 to 159 min with an average of(146±43)min,and the cross clamp time was 60 to 79 min with an average of(66±15)min. CPB time of type Ⅲ patients was 240 to 280 min with an average of(260±28)min,and the arrest time was 20 to 27 min with an average of(24±3)min. The mean hemorrhage volume of the entire group was(500±250)ml. The mean ICU retention time was(5.0±1.5)d and the length of stay was(15.0±2.5)d.Three patients died during perioperative period.Two patients appeard cerebrovascular accident after operation.One patient appeard descending aorta dilation in the follow-up of 2 to 21 months.Conclusion Different clinical manifestations and treatment should be selected according to the different condition of aortic dissection aneurysm.