Kurata H, Kondoh J, Sohma T, Adachi R, Imoto K, Kajiwara H, Mashimo Y, Hoshino K, Tobe M, Matsumoto A
Department of Surgery, Yokohama Municipal Citizen's Hospital, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1990 Feb;38(2):234-9.
From 1981 to 1987 most of DeBakey III type dissecting aneurysms and a part of descending aortic aneurysms were treated by thromboexclusion technique. The effects of the operation by thromboexclusion technique on the patients were compared with those of the operation by temporary bypass technique. Blood loss during an operation was smaller and blood pressure during an operation was more stable in the thromboexclusion technique group, although the difference was not statistically significant. Furthermore, no paraplegia was observed in the thromboexclusion technique group. The respiratory support period was longer and the number of patients with postoperative myocardial injury was greater in the thromboexclusion technique group, although the difference was not statistically significant. Ten patients treated by thromboexclusion techniques were examined by computed tomography. In 7 out of 10 patients (70%), thrombosis occurred in the false lumen of dissecting aneurysm or in the aneurysmal lumen of descending aortic aneurysm. When only the patients without the leakage of blood into the aneurysm through the permanent aortic clamp were examined, thrombosis was observed in 100% of them. Even though the blood flow was reversed, thromboexclusion technique did not have a bad effect on renal function in the long-term. Postoperatively, however, progressive hypertrophy of the left ventricle was recognized, and furthermore, an injury to the aortic wall caused by permanent aortic clamp was observed at an autopsy. This suggests that further long-term follow-up of patients treated by thromboexclusion technique is necessary.
1981年至1987年期间，大部分DeBakey III型夹层动脉瘤和部分降主动脉瘤采用血栓排除技术进行治疗。将采用血栓排除技术手术的患者效果与采用临时旁路技术手术的患者效果进行了比较。血栓排除技术组手术期间的失血量较少，手术期间的血压更稳定，尽管差异无统计学意义。此外，血栓排除技术组未观察到截瘫情况。血栓排除技术组的呼吸支持期较长，术后心肌损伤患者数量较多，尽管差异无统计学意义。对10例采用血栓排除技术治疗的患者进行了计算机断层扫描检查。10例患者中有7例（70%）在夹层动脉瘤假腔或降主动脉瘤瘤腔内发生血栓形成。当仅对未通过永久性主动脉夹使血液漏入动脉瘤的患者进行检查时，100%的患者观察到血栓形成。即使血流逆转，血栓排除技术从长期来看对肾功能也没有不良影响。然而，术后发现左心室进行性肥厚，此外，在尸检时观察到永久性主动脉夹对主动脉壁造成的损伤。这表明有必要对采用血栓排除技术治疗的患者进行进一步的长期随访。
