Obayashi T, Anzai T, Sakata Y, Kodama H, Yanagisawa H
Second Department of Surgery, Gunma University School of Medicine.
Kyobu Geka. 1990 Oct;43(11):924-8.
A 63-year-old man of thoracoabdominal aortic aneurysm was transferred to our department. Thoracic and abdominal enhanced CT scan revealed a Crawford's type I A thoracoabdominal aortic aneurysm ruptured into the right extrapleural and retroperitoneal spaces. Without any more additional examination, graft replacement and reconstruction of a lower intercostal artery were performed with an aid of femoro-femoral bypass. Although the postoperative course was complicated by hypertension, hypoventilation and liver dysfunction, the patient recovered from the operation and 10 months later he is leading an almost normal life. Since emergency operation of thoracoabdominal aneurysm is the most courageous challenge because of the difficulties of exposure and visceral organ protection against ischemic, there have been only nine cases with successful surgery in Japan. Now we actively reconstruct lower intercostal and lumbar arteries to prevent spinal cord ischemia without ESCP monitoring in emergency cases.
一名63岁的胸主动脉瘤患者被转至我科。胸腹部增强CT扫描显示，克劳福德I A型胸主动脉瘤破裂至右侧胸膜外和腹膜后间隙。未进行更多额外检查，在股-股旁路辅助下进行了移植物置换及肋间动脉重建。尽管术后过程出现了高血压、通气不足和肝功能障碍等并发症，但患者术后康复，10个月后几乎恢复正常生活。由于胸腹主动脉瘤急诊手术在暴露及防止内脏器官缺血方面存在困难，堪称最具挑战性的手术，在日本仅有9例手术成功的病例。目前，我们在急诊病例中积极重建肋间动脉和腰动脉以预防脊髓缺血，且不进行ESCP监测。
