摘要目的探讨总结主动脉根部替换术的手术适应证、手术技术和经验.方法 1994年1月至1999年8月,我院共完成231例主动脉根部替换术,其中急诊手术13例.男189例,女42例.年龄14-69岁.瘤体直径5-11厘米.单纯主动脉根部瘤145例,DeBakeyⅠ型主动脉夹层65例,DeBakeyⅡ型主动脉夹层21例.手术以复合带瓣人工血管组件替换主动脉根部229例,行保留主动脉瓣的主动脉根部替换术2例.结果围术期死亡7例,死亡率为3.03%.早期并发症包括:二次开胸止血6例,心包积液9例,脑栓塞、胸腔积液和气胸各2例,均治愈.随诊175例(78.12%),平均随诊时间15.7月±13.1月(2周-65个月).随诊期1例死于术后3个月双下肢动脉栓塞、肾功能衰竭.3例术后因抗凝意外死亡.与术前比较,术后平均左室舒张末径由术前的68.1 mm±9.4 mm(54-112mm)恢复为54.8 mm±8.2mm(38-83 mm)毫米,两者间有显著性差异(P＜0.001).结论对于非夹层的主动脉瘤和慢性主动脉夹层,如果动脉瘤直径超过5厘米,就应该进行手术治疗.主动脉夹层自然病程险恶,一旦确诊,在全身状况允许的条件下应尽早手术.

abstractsObjective To report our operative experience with aortic root replacement in 231 patients with aortic root aneurysm and discuss the current indications,methods,and surgical techniques.Methods Between January 1994 and August 1999,a group of 231 consecutive patients underwent aortic root replacement at our hospital,with 13 being treated on an emergency basis.There were 189 men and 42 women,ranging in age from 14 to 69 years.The diameter of the aneurysm varied from 4.5 to 11 cm.Among this group,145 had isolated aortic root aneurysms,65 suffered from DeBakey type Ⅰ aortic dissection,and the remaining 21 were diagnosed as having DeBakey type Ⅱ aortic dissection.Aortic valve regurgitation occurred in all cases.Aortic root replacement was performed with composite valved graft in 229 patients,and in 2 patients the aortic valve was preserved.Results The hospital mortality rate was 3.03%(7 patients).Early complications included re-exploration for bleeding in 6 patients,pericardial effusion in 9,as well as cerebral infarction,pleural effusion,and pneumothorax in 2 patients each.One hundred and seventy-five patients(78.12%)were followed up,with a mean follow-up time of 15.7 ± 13.1 months(range,2 weeks to 65 months).One patient died from lower-limb embolism and renal dysfunction 3 months postoperatively.Three patients died from postoperative anticoagulation accidents.The preoperative and postoperative mean left ventricular end-diastolic diameters were significantly different(68.1 ± 9.4 mm,range 54 to 112 mm;vs 54.8 ± 8.2 mm,range 38 to 88 mm;P＜0.001).Conclusions Once a diagnosis of acute aortic root dissecting aneurysm is made,the patient should undergo surgery as soon as possible if the general conditions permit.Aortic aneurysm without dissection or with chronic dissection should be operated if the diameter of the aneurysm is greater than 5 cm.