Belov Iu V, Stepanenko A B, Gens A P, Radnaev Ch D
Khirurgiia (Mosk). 2004(8):17-21.
Surgical treatment of patients with thoracic and thoracoabdominal aortic aneurysms is one of the most difficult and topical problems of up-to-date cardio-vascular surgery. Right choice of surgical approach is important condition for effective surgery. This study is dedicated to comparative evaluation and definition of clear indication for choice of surgical approach in reconstruction of thoracic aneurysms. It is concluded that thoracotomy through 3(rd) intercost is preferable in isolated lesion of isthmus and proximal part of descending aorta. Approach through 5(th) intercost is not recommended in this localization of aneurysm. Prosthesis of all descending thoracic aorta (from arch to diaphragm) must be performed through double left-sided thoracotomy with single skin incision (left-sided double thoracotomy through 3(rd) and 6(th) intercosts from single S-type skin incision). This approach always permits to perform surgical reconstruction of distal part of aortic arch, isthmus and all descending aorta, forms optimal conditions for creation of proximal and distal anastomosis.
胸主动脉和胸腹主动脉瘤患者的外科治疗是当代心血管外科最困难且热门的问题之一。正确选择手术入路是有效手术的重要条件。本研究致力于对胸主动脉瘤重建手术入路选择的明确指征进行比较评估和界定。得出的结论是，对于峡部及降主动脉近端的孤立性病变，经第三肋间开胸术较为可取。在此动脉瘤定位情况下，不建议经第五肋间入路。所有降胸主动脉（从主动脉弓至膈肌）的假体植入必须通过双侧单切口开胸术（从单一S型皮肤切口经第三和第六肋间进行左侧双侧开胸术）。这种入路总能进行主动脉弓远端、峡部及所有降主动脉的手术重建，为建立近端和远端吻合创造最佳条件。
