Nakajima N, Watanabe H, Takahara Y, Uemura S, Murayama H, Takeuchi S
First Department of Surgery, Chiba University School of Medicine, Japan.
Jpn J Thorac Cardiovasc Surg. 1998 Mar;46(3):274-9. doi: 10.1007/BF03217742.
A retrospective study was conducted for the surgical treatment on acute aortic dissection among the cardiovascular services of 5 affiliated hospital of medical school. The total of 74 cases were operated for the last 5 years period from Jan., 1991 to Dec., 1995, in which 64 cases were classified as Type A and 10 for Type B. The average age for Type A was 58.4 years old and 10% of patients were consisted of Marfan syndrome. The most frequent complications associated with dissection was aortic regurgitation (37.5%), followed by cardiac tamponade (23.4%). The surgeries were undertaken in less than 24 hours from the onset of symptom in 45.3% of patients. The localization of initial tear as was proved by intraoperative finding was at ascending aorta in 64.0%, whereas it was found at aortic arch in 21.8% of patients. The most frequent application of operative procedure was simultaneous graft replacement of ascending aorta and aortic arch (68.7%) with the use of profound hypothermia and antegrade selective cerebral perfusion (85.4%). The overall mortality rate was 25.0%, however when compared as ascending only vs ascending + arch replacement, the later group demonstrated higher mortality rate (16.6% vs 28.9%). The majority of surgical indication for Type B was hemorrhage from the dissection and 20.0% of mortality was recorded in this group of patients.
对某医学院5家附属医院心血管科的急性主动脉夹层手术治疗进行了一项回顾性研究。在1991年1月至1995年12月的过去5年期间，共对74例患者进行了手术，其中64例为A型，10例为B型。A型患者的平均年龄为58.4岁，10%的患者患有马凡综合征。与夹层相关的最常见并发症是主动脉瓣关闭不全（37.5%），其次是心脏压塞（23.4%）。45.3%的患者在症状出现后不到24小时内接受了手术。术中发现最初撕裂的部位在升主动脉的占64.0%，而在主动脉弓的占21.8%。最常应用的手术方法是同时进行升主动脉和主动脉弓置换术（68.7%），采用深低温和顺行性选择性脑灌注（85.4%）。总体死亡率为25.0%，然而，仅升主动脉置换与升主动脉+主动脉弓置换相比，后一组的死亡率更高（16.6%对28.9%）。B型的大多数手术指征是夹层出血，该组患者的死亡率为20.0%。
