Belov Iu V
Khirurgiia (Mosk). 1998(6):16-20.
The aim of the study was simplification of the method of prosthetic reconstruction of the ascending aorta for its aneurysm by resection of mathematically calculated area of the aortic wall with creation of supporting prosthesis around the patient's own aorta to prevent development of the aneurysm in the future. 9 patients were operated on for the aneurysm of the ascending aorta with aortal insufficiency. 7 male patients, 2 female. Age varied from 43 to 67 years (mean age--52 years). Etiology of the disease in 7 cases was degenerative changes of the aortic wall (cystomedionecrosis--syndrome of Ertheim), atherosclerosis and lues (one case each). Diameter of the aneurysm made up to 5-8 cm. The operation consists in the preservation of the patient's own aortic wall with intima, removal of previously calculated maximally thinned aortic wall and creation of supporting synthetic frame for the aorta, taking over all the load on the aortic wall. Before the operation the diameter of the normal (DN) aorta is measured above the aneurysm, for example, at the level of brachiocephalic trunk or descending aorta. Maximal diameter of the aneurysm (da) is measured. Perimeter of the aorta subjected to resection is calculated (X) according to the formula: X = pi(da - dn). In 7 patients only this operation was performed, in two--it was combined with aorto-coronary bypass, in one case from the ascending aorta and in the other--from brachiocephalic trunk together with prosthetic reconstruction of the abdominal aorta for aneurysm with replantation of the inferior mesenteric artery into the side of the prosthesis. There were neither no complications lethal outcomes in the nearest and far-off (up to 2 years) postoperative period in all patients. The authors believe that this operation should be the method of choice in treatment of patients with aneurysm of the ascending aorta without aortal insufficiency.
本研究的目的是简化升主动脉瘤的人工修复方法，即通过切除经数学计算的主动脉壁区域，并在患者自身主动脉周围制作支撑假体，以防止未来动脉瘤的发展。9例升主动脉瘤合并主动脉瓣关闭不全的患者接受了手术。其中男性7例，女性2例。年龄在43岁至67岁之间（平均年龄52岁）。7例患者的病因是主动脉壁退行性变（囊肿性中层坏死——埃尔瑟姆综合征），动脉粥样硬化和梅毒各1例。动脉瘤直径达5 - 8厘米。手术包括保留患者自身带有内膜的主动脉壁，切除先前计算出的最薄主动脉壁，并为主动脉制作支撑性合成框架，以承担主动脉壁的所有负荷。手术前，在动脉瘤上方测量正常主动脉（DN）的直径，例如在头臂干或降主动脉水平。测量动脉瘤的最大直径（da）。根据公式计算要切除的主动脉周长（X）：X = π(da - dn)。7例患者仅进行了此手术，2例患者进行了此手术并联合主动脉冠状动脉搭桥术，1例从升主动脉进行搭桥，另1例从头臂干进行搭桥，同时对腹主动脉瘤进行假体修复，并将肠系膜下动脉重新植入假体侧面。所有患者在近期和远期（长达2年）术后均未出现并发症及致命后果。作者认为，对于无主动脉瓣关闭不全的升主动脉瘤患者，该手术应作为首选治疗方法。
