Pillet J, Enon B, Lescalie F, Reigner B, Mercier P
Service de Chirurgie Cardiovasculaire et Thoracique, Hôpitaux, CHU, Angers.
J Chir (Paris). 1992 Oct;129(10):426-32.
Although their frequency is probably underestimated, medullary complications of abdominal aorta surgery are rare but serious, and may be the cause of medico-legal actions. Referral of a patient allowed the collection of 26 unpublished cases: 18 with aneurysms, including 6 ruptured lesions and 12 undergoing cold surgery, and 8 with aorto-iliac occlusion, these 26 cases representing 0.16% of abdominal aorta interventions performed during the same period. Mortality (6 cases) was due principally to neurological complications, total in 4 cases, partial in 3 and persistent in 13. Risk factors were perioperative collapse (explaining the elevated frequency in ruptured aneurysms) and the occlusion of the internal iliac arteries. Duration of clamping was not significant. No certain method of prevention could be elucidated, either by a literature review or by analysis of the personal series.
尽管腹主动脉手术的髓质并发症发生率可能被低估,但这类并发症罕见却严重,可能引发医疗法律纠纷。通过转诊收集到26例未发表的病例:18例为动脉瘤,其中6例为破裂病变,12例接受了冷冻手术;8例为腹主动脉-髂动脉闭塞。这26例病例占同期腹主动脉手术的0.16%。死亡(6例)主要归因于神经并发症,完全性神经并发症4例,部分性3例,持续性13例。危险因素为围手术期虚脱(解释了破裂动脉瘤中此类并发症发生率较高的原因)和髂内动脉闭塞。夹闭持续时间无显著影响。无论是文献综述还是对个人病例系列的分析,都未能阐明确切的预防方法。