Hashimoto A
Kyobu Geka. 1989 Jul;42(8 Suppl):641-6.
During 23 years, from 1965 to August 1988, 264 patients with thoracic and thoracoabdominal aortic aneurysms including dissecting aneurysms were operated upon, and the overall operative mortality was 19.1%. Before the midst of 1972, the surgical mortality was 55%, but after the midst of 1972 it was 13.1%, and for the most recent 5 years it was only 7.8%. Experiences of the surgical treatment of true aneurysms of the each segments of the aorta, ie, ascending, transverse arch, descending thoracic, and thoracoabdominal, as well as the surgical treatment of the dissecting aneurysms, were reviewed. Factors contributing to the progress in the surgical treatment of the aortic aneurysms were 1) graft inclusion technique in which Bentall's procedure was included, 2) improved cardioplegic technique, 3) temporary long external bypass, 4) left heart bypass with a Biopump without total body heparinization, 5) deep hypothermia, and 6) open distal anastomosis for the transverse arch replacement. At the present time, there are several problems to be solved, that are further improvement of surgical treatment of the dissecting aneurysms of the aorta, prevention of the postoperative hemiplegia, and further improvement of the long term results after surgical treatment of aneurysms of the aorta.
在1965年至1988年8月的23年间，对264例包括夹层动脉瘤在内的胸主动脉和胸腹主动脉瘤患者进行了手术，总体手术死亡率为19.1%。1972年年中之前，手术死亡率为55%，但1972年年中之后为13.1%，最近5年仅为7.8%。回顾了主动脉各段真性动脉瘤的外科治疗经验，即升主动脉、横弓、降主动脉和胸腹主动脉，以及夹层动脉瘤的外科治疗经验。主动脉瘤外科治疗取得进展的因素包括：1）采用包含Bentall手术的移植物植入技术；2）改进的心内直视停搏技术；3）临时长体外旁路；4）使用Biopump进行左心旁路且无需全身肝素化；5）深低温；6）横弓置换术的开放远端吻合。目前，仍有几个问题有待解决，即进一步改进主动脉夹层动脉瘤的外科治疗、预防术后偏瘫以及进一步改善主动脉瘤外科治疗后的长期效果。
