Griepp Randall B, Griepp Eva B
Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, New York, USA.
Ann Thorac Surg. 2007 Feb;83(2):S865-9; discussion S890-2. doi: 10.1016/j.athoracsur.2006.10.092.
In the last two decades, as an increasing number of patients with descending thoracic and thoracoabdominal aneurysms are being diagnosed and treated, a more sophisticated understanding of spinal cord perfusion has become important in the attempt to minimize the frequency of spinal cord injury. The synthesis of information from laboratory studies and clinical experience has led to the collateral network concept, a framework for understanding spinal cord perfusion and thereby improving spinal cord protection during treatment of aneurysmal disease of the aorta distal to the left subclavian artery. Application of principles based on the collateral network concept has resulted in falling rates of spinal cord injury, which now approach 1% in descending thoracic aneurysm resection and less than 10% in extensive thoracoabdominal resections. These accomplishments suggest that, with further investigation, routine sacrifice of segmental aortic branches can be carried out in a way that will allow surgical and endovascular therapy of extensive distal aortic aneurysms without neurologic injury.
在过去二十年中，随着越来越多的降胸段和胸腹段动脉瘤患者得到诊断和治疗，为尽量减少脊髓损伤的发生率，对脊髓灌注有更深入的了解变得至关重要。实验室研究和临床经验信息的综合产生了侧支网络概念，这是一个用于理解脊髓灌注从而在治疗左锁骨下动脉远端主动脉瘤性疾病期间改善脊髓保护的框架。基于侧支网络概念的原则的应用已导致脊髓损伤发生率下降，目前降胸段动脉瘤切除术的发生率接近1%，广泛胸腹段切除术的发生率不到10%。这些成果表明，随着进一步研究，节段性主动脉分支的常规牺牲可以以一种允许对广泛的远端主动脉瘤进行手术和血管内治疗而不造成神经损伤的方式进行。
