CAJ | 학술논문

目的探讨主动脉缩窄合并主动脉B型夹层的手术方法选择和预后.方法 2009年至2013年,10例主动脉缩窄合并B型主动脉夹层患者接受外科手术治疗.男7例,女3例;年龄为23～ 56岁,平均41.2岁.患者均经主动脉CTA确诊.根据患者主动脉弓部发育情况、降主动脉瘤样扩张程度和夹层累及范围决定手术方式.侧开胸手术7例,其中3例行胸降主动脉替换术,3例行部分胸降主动脉替换术加短支架象鼻置入术,1例行全胸腹主动脉替换术.正中开胸开腹手术3例,均行升主动脉-腹主动脉转流术+主动脉弓远端结扎术.结果手术死亡1例,为主动脉弓发育不良、右侧胸腔大量血性积液,行升主动脉-腹主动脉转流加主动脉弓和胸降主动脉远端结扎术者,术后2天因主动脉破裂死亡.余无并发症发生.随访8～38个月,无主动脉相关死亡和再次手术.结论根据主动脉缩窄合并B型主动脉夹层患者主动脉弓部发育情况、降主动脉瘤样扩张程度和夹层累及范围个体化决定手术方式,可获得满意的治疗效果.
목적 탐토주동맥축착합병주동맥B형협층적수술방법선택화예후.방법 2009년지2013년,10례주동맥축착합병B형주동맥협층환자접수외과수술치료.남7례,녀3례;년령위23～ 56세,평균41.2세.환자균경주동맥CTA학진.근거환자주동맥궁부발육정황、강주동맥류양확장정도화협층루급범위결정수술방식.측개흉수술7례,기중3례행흉강주동맥체환술,3례행부분흉강주동맥체환술가단지가상비치입술,1례행전흉복주동맥체환술.정중개흉개복수술3례,균행승주동맥-복주동맥전류술+주동맥궁원단결찰술.결과 수술사망1례,위주동맥궁발육불량、우측흉강대량혈성적액,행승주동맥-복주동맥전류가주동맥궁화흉강주동맥원단결찰술자,술후2천인주동맥파렬사망.여무병발증발생.수방8～38개월,무주동맥상관사망화재차수술.결론 근거주동맥축착합병B형주동맥협층환자주동맥궁부발육정황、강주동맥류양확장정도화협층루급범위개체화결정수술방식,가획득만의적치료효과.
Objective To summarize the methods and results of surgical treatment of coarctation of the aorta associated with aortic dissection.Methods Analyzed the clinical data of 10 patients with aortic coarctation associated type B aortic dissection who underwent one-stage surgical repair between 2011 and 2013 in Anzhen Hospital.There were 7 males and 3 females with the age ranged from 23 to 56 years,average at 41.2 years.All patients were diagnosed by UCG and CTA.There are three key points to determine the operation method,diameter of the aortic arch and descending aorta,and the extent of dissection.Descending thoracic aortic replacement with short stented elephant trunk was performed in 3 patients,thoracic and abdominal aortic replacement in 1 patient,ascending-abdominal aorta bypass with arch or descending aortic ligature in 3 patients.Results One hospital death occurred(10％).There was no severe surgical complication.No death or reoperation occurred during follow up period.Conclusion Aortic coarctation associated type B aortic dissection is a rare and complex disease.Surgical treatment is an effective and safe method for the disease.