Furukawa H, Tsuchiya K, Osawa H, Saito H, Iida Y
Department of Cardiovascular Surgery, Yamanashi Prefectural Central Hospital, Japan.
Jpn J Thorac Cardiovasc Surg. 1999 Jun;47(6):277-80. doi: 10.1007/BF03218010.
A 76 year old woman had suffered from chest pain, back pain, and dysphagia for 8 months. She was diagnosed as having a thoracic aortic aneurysm by chest X-ray and chest enhanced computed tomography. Simultaneously, severe dysphagia developed. Chest enhanced computed tomography and chest aortic aortography at our hospital demonstrated a saccular descending thoracic aortic aneurysm. Esophagography demonstrated that the esophagus was compressed by the aneurysm; therefore, a graft replacement for the saccular descending thoracic aortic aneurysm was performed on February 17th, 1998. A left sided 6th intercostal approach was made, and graft replacement for the aneurysm using a 22 mm Hemashield prosthetic graft was performed under temporary bypass from the thoracic aorta just distal to the left subclavian artery and to the left femoral artery. The postoperative course was uneventful, the severe dysphagia improved dramatically, but a pleural effusion of 1000 ml collected 3 weeks after the operation. Surgical cases of saccular descending thoracic aortic aneurysm with dysphagia are rare, and with this in mind, we report this case to the the medical literature.
一名76岁女性胸痛、背痛及吞咽困难8个月。胸部X线及胸部增强计算机断层扫描诊断为胸主动脉瘤。同时，出现严重吞咽困难。我院胸部增强计算机断层扫描及胸主动脉造影显示为囊状降主动脉瘤。食管造影显示食管被动脉瘤压迫；因此，1998年2月17日对囊状降主动脉瘤进行了人工血管置换术。采用左侧第6肋间入路，在左锁骨下动脉远端的胸主动脉至左股动脉进行临时搭桥，使用22mm Hemashield人工血管对动脉瘤进行人工血管置换。术后过程顺利，严重吞咽困难明显改善，但术后3周出现1000ml胸腔积液。伴有吞咽困难的囊状降主动脉瘤手术病例罕见，考虑到这一点，我们将该病例报告至医学文献。
