Nakajima N, Adachi S, Ando M, Nakatani M, Kawashima Y
Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Japan.
Nihon Geka Gakkai Zasshi. 1992 Sep;93(9):1036-9.
It is obvious that there are many controversies regarding to the treatment of aortic dissection. In this report, we discuss following points such as 1) classification, 2) thrombosed type dissection, and 3) simultaneous graft replacement of ascending and aortic arch with the reconstruction of cervical branches. From the patho-morphological status, dissection will be classified into two types, localized and extended types. From the anatomical and surgical points of view, it will be also classified as 1) ascending-arch, 2) descending-thoracoabdominal, and 3) abdominal. With the combination of these two, dissection will be classified more clearly. The thrombosed type will be incorporated into localized type. We have experienced 76 cases of this dissection, and clinical features and outcome by medical treatment only are presented. The simultaneous reconstruction of ascending aorta and aortic arch for the dissection at ascending-arch type was undertaken in total of 35 patients. The surgical results as well as follow up data are presented and the benefit of this extended procedure is presented as well.
显然，关于主动脉夹层的治疗存在许多争议。在本报告中，我们讨论以下几点，如1）分类，2）血栓形成型夹层，以及3）升主动脉和主动脉弓的同期移植置换及颈部分支的重建。从病理形态学状态来看，夹层可分为局限性和扩展性两种类型。从解剖学和手术学角度来看，它也可分为1）升主动脉-弓型，2）降主动脉-胸腹型，以及3）腹型。将这两种分类方法结合起来，夹层的分类会更清晰。血栓形成型将并入局限性类型。我们已诊治过76例这种夹层患者，并仅介绍了单纯药物治疗的临床特征和结果。对于升主动脉-弓型夹层，共有35例患者接受了升主动脉和主动脉弓的同期重建。文中展示了手术结果以及随访数据，并阐述了这种扩展手术的益处。
