| 杨新超1 柳德斌2△ 王炜2 王玮璠2 徐学增2.91例主动脉夹层动脉瘤的临床治疗体会[J].,2014,14(20):3869-3872 |
| 91例主动脉夹层动脉瘤的临床治疗体会 |
| Clinical Experience of the Treatment of 91 Casesof Aortic Dissecting Aneurysm |
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| DOI： |
| 中文关键词: 腔内修复术 主动脉瘤 杂交手术 |
| 英文关键词: Endovascular aneurysmrepair Aortic aneurysm Hybrid procedure |
| 基金项目: |
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| 中文摘要: |
| 摘要目的：依据临床经验，熟练运用开放手术、腔内修复术及杂交手术方法治疗各类主动脉夹层动脉瘤。方法：收集2009 年7
月～2013 年1 月在我院手术治疗的主动脉夹层动脉瘤患者共91 例，StanfordB 型夹层动脉瘤36 例(其中21 例降主动脉瘤、9 例
腹主动脉及双髂动脉瘤行腔内覆膜支架隔绝术，6 例行腹主动脉人工血管置换术)，StanfordA 型夹层动脉瘤55 例(其中单纯Sun,s
手术12 例伴Bentall 术6 例，Bentall 术伴部分主动脉弓人工血管置换36 例，1 例行Ⅱ型的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杂交术)，分别以不同的手术方法给予治疗。结果：顺利治愈出院85 例，死亡6 例，4 例因全弓置换术
后出现难以控制的大出血、肠坏死、肾功能不全、少尿等并发症而死亡，2 例死于Bentall 术后严重多功能脏器急性衰竭，1例杂交
手术术后出现高血压伴神经系统并发症，1 例伴肺部感染及低心排综合征，给予对症治疗后效果不佳，有2 例出现肾功能不全，经
过透析治愈。腔内修复术后有神经系统的并发症2 例，下肢的功能障碍2 例，少量内漏4 例，以上并发症均经对症治疗后痊愈。术
后随访76 例，时间3～12 个月，除2 例于术后第9 个月死亡、1 例因脑梗塞、脑血管意外等与手术无关的疾病而死亡，2 例因吻合
口动脉瘤或动脉瘤破裂大出血死亡外，余患者生活状态良好，心功能在I～Ⅱ级。结论：根据主动脉瘤疾病的临床特点和定位诊
断，合理选择和运用治疗方法使手术操作变得更为迅速、安全和方便，同时能够取得良好的临床治疗效果。 |
| 英文摘要: |
| ABSTRACT Objective:According to the clinical experience, open surgery, endovascular aneurysm repair and hybrid operation
technique in the clinical treatment of aortic dissecting aneurysm were skillfully used. Methods:From July 2009 to January 2013, we
collected 91 patients with aortic dissection aneurysm who underwent surgical treatment in our hospital, 36 Stanford B dissecting
aneurysm and 55 Stanford A dissecting aneurysm ,which were treated through different methods.Results: 85 patients were successfully
cured, 6 cases died, 4 cases with total arch replacement died of a series of complications such as uncontrollable bleeding, intestinal
necrosis, renal insufficiency, and oliguria. 2 cases died of severe multi-function acute organ failure, 1 case of hybrid surgery appeared
hypertension and neurological complications, 1 lung infection and low cardiac syndrome, the effect was not optimal. 2 cases with renal
insufficiency were cured after dialysis treatment. 2 cases appeared neurological complications after endovascular aneurysm repair, 2
lower limb dysfunction, 4 cases had a little leakage. These complications were cured after symptomatic treatment. 76 cases were
postoperatively followed-up for 3-12 months, 2 cases died at 9 months, 1 case died of cerebral infarction and cerebrovascular accident, 2
cases died of hemorrhage, other patients lived in good condition with the I -Ⅱ level of cardiac function. Cconlusion:According to the
clinical characteristics of aortic aneurysm disease and localization diagnosis, reasonably select and use of methods to make the operation
become faster, safer and more convenient, which could achieve good therapeutic effect at the same time. |
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