对患有或不患有马凡综合征的患者进行广泛主动脉夹层的全主动脉置换和次全主动脉置换。
Total and subtotal aortic replacement for extensive aortic dissection in patients with or without Marfan's syndrome.
作者信息
Yamashita Katsushi, Kazui Teruhisa, Terada Hitoshi, Washiyama Naoki, Suzuki Takayasu, Ohkura Kazuhiro, Doi Hirosato, Okawa Yohei, Suzuki Kazuchika, Ono Takemi
机构信息
First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan.
出版信息
Jpn J Thorac Cardiovasc Surg. 2002 Aug;50(8):315-20. doi: 10.1007/BF03032623.
OBJECTIVES
Extensive aortic dissection with multiple entries often found in Marfan's syndrome patients ultimately requires replacement of the whole aorta. We present a surgical strategy and results for total and subtotal aortic replacement.
METHODS
Subjects were 18 patients, including 14 Marfan's patients undergoing total (n = 13) or subtotal (excluding aortic arch) aortic replacement (n = 5), for DeBakey type I aortic dissection (n = 13) and DeBakey type IIIb aortic dissection with annuloaortic ectasia (n = 5) between February 1991 and April 2001. Mean age was 39.9 +/- 0.8 years--34.9 +/- 6.6 years in Marfan's patients vs. 57.7 +/- 4.7 years in non-Marfan patients. All operations were staged, with the mean number required per patient 3.1 +/- 0.8.
RESULTS
Early mortality was 0% and late mortality 11% (2 of 18). Paraplegia or paraparesis occurring in 11%. Except for these patients, all current survivors enjoy good quality of life.
CONCLUSIONS
Total and subtotal aortic replacement for extensive aortic dissection may decrease mortality due to rupture or associated disease.
目的
马方综合征患者常出现广泛的主动脉夹层并有多个破口，最终需要置换整个主动脉。我们介绍全主动脉和次全主动脉置换的手术策略及结果。
方法
研究对象为18例患者，包括14例马方综合征患者，其中13例行全主动脉置换，5例行次全主动脉置换（不包括主动脉弓），分别针对1991年2月至2001年4月期间的Ⅰ型主动脉夹层（13例）和伴有主动脉瓣环扩张的Ⅲb型主动脉夹层（5例）。平均年龄为39.9±0.8岁——马方综合征患者为34.9±6.6岁，非马方综合征患者为57.7±4.7岁。所有手术均分期进行，每位患者平均需要3.1±0.8次手术。
结果
早期死亡率为0%，晚期死亡率为11%（18例中有2例）。截瘫或轻截瘫发生率为11%。除这些患者外，所有目前的幸存者生活质量良好。
结论
对于广泛的主动脉夹层，全主动脉和次全主动脉置换可能会降低因破裂或相关疾病导致的死亡率。
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