Coselli Joseph S, Conklin Lori D, LeMaire Scott A
The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
Ann Thorac Surg. 2002 Nov;74(5):S1881-4; discussion S1892-8. doi: 10.1016/s0003-4975(02)04139-5.
Surgical repair of thoracoabdominal aortic aneurysms remains a technically challenging operation that requires a multimodality approach to preventing ischemic complications. The purpose of this report is to update our experience and highlight our current clinical strategies.
Between January 1, 1986 and December 31, 2001, 1,773 patients underwent thoracoabdominal aortic aneurysm repair. The majority of these patients (1,153, 65%) required Crawford extent I or II repairs. Segmental intercostal or lumbar arteries were reattached in 1,082 patients (61%); left heart bypass was used in 686 patients (38.7%), and 173 patients (9.8%) had cerebrospinal fluid drainage.
The 30-day survival rate was 94.3% (1,672 patients). Postoperative complications included renal failure requiring hemodialysis in 105 patients (5.9%) and paraplegia or paraparesis in 79 patients (4.5%). Actuarial 5-year survival was 73.5% +/- 1.6%.
This clinical experience demonstrates that current technical strategies enable patients to undergo thoracoabdominal aortic aneurysm repair with excellent early survival and acceptable morbidity.
胸腹主动脉瘤的外科修复仍然是一项技术上具有挑战性的手术，需要采用多模式方法来预防缺血性并发症。本报告的目的是更新我们的经验并突出我们目前的临床策略。
在1986年1月1日至2001年12月31日期间，1773例患者接受了胸腹主动脉瘤修复手术。这些患者中的大多数（1153例，65%）需要进行克劳福德I型或II型修复。1082例患者（61%）进行了节段性肋间或腰动脉再植；686例患者（38.7%）使用了左心转流，173例患者（9.8%）进行了脑脊液引流。
30天生存率为94.3%（1672例患者）。术后并发症包括105例患者（5.9%）需要进行血液透析的肾衰竭和79例患者（4.5%）的截瘫或轻瘫。5年精算生存率为73.5%±1.6%。
这一临床经验表明，目前的技术策略使患者能够接受胸腹主动脉瘤修复手术，早期生存率良好，发病率可接受。
