Bentall H H
Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London, England, UK.
Jpn J Surg. 1987 Nov;17(6):425-30. doi: 10.1007/BF02470744.
The author briefly reviews the early operations of treatment of aortic aneurysm and aortic regurgitation leading to his description, in 1968, of the first composite graft replacement of the ascending aorta and aortic valve, with anastomosis of the coronary arteries into the graft. The original operation is described with reference to modifications suggested by a number of authors throughout the last 20 years. Methods of achieving coronary artery continuity by Carrel patch and pull-through by saphenous vein interposition and by synthetic graft techniques are discussed. While any of these methods may be needed in individual cases the preference of the author remains for simplicity. The arguments for and against excision of the aneurysmal sac are considered in relation to the control of haemorrhage. The early and medium term results of operation are good but in comparing results world-wide a lack of uniform diagnostic criteria is apparent. The full clinical Marfan syndrome presents little difficulty but the status of "annuloaortic ectasia", Erdheim's medionecrosis, "cystic medial necrosis" and many other pathological descriptions are not defined: "forme fruste" of Marfan's disease has been used for any of the above. Interpretation of surgical results remains difficult and often impossible in the absence of clear definitions. Recent work on elastic tissue and on the chemistry of collagen together with the hope of identification of the genetic background now offers real hope of clearer understanding.
作者简要回顾了主动脉瘤和主动脉反流的早期治疗手术，这些手术促使他在1968年描述了首例升主动脉和主动脉瓣复合移植术，并将冠状动脉吻合到移植物中。文中参照了过去20年多位作者提出的改进意见描述了最初的手术。讨论了通过卡雷尔补片、大隐静脉插入和合成移植物技术实现冠状动脉连续性的方法。虽然个别病例可能需要这些方法中的任何一种，但作者仍然倾向于采用简单的方法。结合出血控制情况，对是否切除动脉瘤囊的正反两方面观点进行了考量。手术的早期和中期结果良好，但在比较全球范围内的结果时，明显缺乏统一的诊断标准。完全型临床马方综合征诊断起来没什么困难，但“主动脉环扩张症”、埃尔德海姆中膜坏死、“囊性中膜坏死”以及许多其他病理描述的情况尚不明确：马方综合征的“顿挫型”已被用于上述任何一种情况。在缺乏明确界定的情况下，对手术结果的解读仍然困难，而且往往无法进行。最近关于弹性组织和胶原蛋白化学的研究，以及对确定遗传背景的期望，现在为更清晰的理解带来了真正的希望。
