Ueda T, Hayashi I, Kurosaka Y, Izeki H, Onoguchi K, Taguchi S, Kawada K
Section of Cardiovascular Surgery, Seiranso National Sanatorium Hospital, Ibaraki, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1990 Jun;38(6):1017-22.
Ten patients underwent repair of aneurysms of the distal aortic arch from 1985 to 1989. There were 8 men and 2 women: aged 58 to 77 (average age 67 years). Seven patients had sacciform aneurysms which were closed by graft patch aortoplasty, and three patients had fusiform aneurysms which were corrected by inserting tube grafts. Seven aneurysms operated since 1988 were approached through median sternotomy continued with left anterior thoracotomy, so called door open method. This approach presented good view of the diseased aorta, and effective for preventing recurrent and phrenic nerve palsy. We used temporary bypass for 4 patients, cardiopulmonary bypass for 4 patients (separate carotid artery perfusion for 2 patients) and centrifugal pump for 2 patients during aortic cross clamping. One patient died intraoperatively from intractable bleeding and two patients died postoperatively from brain damage due to embolic episodes during the operations. These patients showed the severely irregular intima in the aortic arch and were complicated with rupture of the aneurysm or dissections arising from the aneurysms. It should be noticed that careless manipulation of the aortic arch and the brachiocephalic vessels cause cerebral complications in such cases.
1985年至1989年期间，10例患者接受了主动脉弓远端动脉瘤修复术。其中男性8例，女性2例；年龄在58岁至77岁之间（平均年龄67岁）。7例患者为囊状动脉瘤，采用移植补片主动脉成形术进行闭合；3例患者为梭形动脉瘤，通过植入管状移植物进行矫正。自1988年以来手术的7例动脉瘤采用正中胸骨切开术加左前开胸术的方式进行处理，即所谓的“开门法”。这种手术方式能很好地显露病变的主动脉，且对预防复发和膈神经麻痹有效。在主动脉阻断期间，4例患者使用了临时旁路，4例患者使用了体外循环（其中2例患者采用单独的颈动脉灌注），2例患者使用了离心泵。1例患者术中死于难以控制的出血，2例患者术后死于手术期间栓塞事件导致的脑损伤。这些患者的主动脉弓内膜严重不规则，并伴有动脉瘤破裂或由动脉瘤引起的夹层。应当注意的是，在此类病例中，对主动脉弓和头臂血管的粗心操作会导致脑部并发症。
