Koja K, Kuniyoshi Y, Miyagi K, Uezu T, Arakaki K, Yamashiro S, Mabuni K, Nagano T, Senaha E, Kakinohana M
Second Department of Surgery, Faculty of Medicine, University of Ryukyu, Okinawa, Japan.
Kyobu Geka. 2004 Apr;57(4):268-73.
Despite improvement in adjuncts for thoracoabdominal aortic aneurysms (TAAA) repairs, many devastating complications remains after the surgery. Our experience with these aneurysms has been reviewed in order to identify those methods at risk of major morbidity, as well as which further improvements required. During last 16 years, 53 consecutive patients were operated on TAAA. The mean age was 58 years. Twenty patients had dissecting aneurysms and 13 patients had had prior aortic surgery. A femoro-femoral bypass was used to maintain distal aortic perfusion in most patients. Reimplantation of intercostal or lumbar arteries under the multi-segmental aortic clamping is consistent in our technique. Motor evoked potentials (MEP) were measured to monitor spinal cord protection since 2000. The hospital mortality was 9.4% (5/53), 22.2% (2/9) for emergency operation and 15.4% (2/13) for patients with prior aortic surgery. The mortality for the first and elective operations was 3.2% (1/31). No any neurologic dysfunction was observed in all patients including the hospital deaths. In view of clinical results, our adjuncts and techniques are useful for prevention of spinal cord ischemia during the TAAA surgery.
尽管胸腹主动脉瘤（TAAA）修复的辅助手段有所改进，但手术后仍存在许多严重并发症。回顾了我们对这些动脉瘤的治疗经验，以确定那些有发生严重并发症风险的方法，以及哪些方面需要进一步改进。在过去16年中，连续53例患者接受了TAAA手术。平均年龄为58岁。20例患者患有夹层动脉瘤，13例患者曾接受过主动脉手术。大多数患者使用股-股旁路来维持主动脉远端灌注。我们的技术一致采用在多节段主动脉阻断下重新植入肋间或腰动脉。自2000年以来，通过测量运动诱发电位（MEP）来监测脊髓保护情况。医院死亡率为9.4%（5/53），急诊手术死亡率为22.2%（2/9），曾接受主动脉手术的患者死亡率为15.4%（2/13）。首次择期手术的死亡率为3.2%（1/31）。包括医院死亡患者在内的所有患者均未观察到任何神经功能障碍。鉴于临床结果，我们的辅助手段和技术对于预防TAAA手术期间的脊髓缺血是有用的。
