Kazui T, Komatsu S, Sasaki T, Yamada O
Department of Thoracic & Cardiovascular Surgery, Sapporo Medical College, Japan.
J Cardiovasc Surg (Torino). 1987 Nov-Dec;28(6):663-70.
Eleven patients in our institution with thoracoabdominal aortic aneurysms involving the celiac, superior mesenteric and renal arteries underwent surgical treatment with the aid of a partial femoro-femoral bypass during the last three years. Three patients with expanding aneurysms underwent emergency operations. Another three patients with extensive aneurysms had two-stage operations: initial aortic arch or descending thoracic graft replacement followed by thoracoabdominal graft replacement in the second stage. Exposure of the aneurysms was made through a left transthoracic, retroperitoneal abdominal approach in all patients. The surgical technique employed in most cases in this series was graft inclusion with direct reattachment of the visceral vessels by anastomosis to an opening made in the graft. Pairs of intercostal and lumbar arteries between the levels of the ninth thoracic and fourth lumbar regions were reconstructed in a similar fashion on the basis of monitoring somatosensory evoked potentials. The operations were performed with the aid of a partial femoro-femoral bypass with selective celiac and renal arterial perfusion in most cases. All patients but one survived the operation and are leading normal lives late in the postoperative period. Graft inclusion with the aid of a partial bypass is a valid technique for the treatment of thoracoabdominal aortic aneurysms involving visceral branches.
在过去三年中，我们机构有11例胸腹主动脉瘤累及腹腔干、肠系膜上动脉和肾动脉的患者，在部分股-股旁路的辅助下接受了手术治疗。3例动脉瘤扩张的患者接受了急诊手术。另外3例广泛动脉瘤患者接受了两阶段手术：第一阶段进行主动脉弓或降主动脉移植置换，第二阶段进行胸腹移植置换。所有患者均通过左胸经腹后腹膜入路暴露动脉瘤。本系列大多数病例采用的手术技术是将移植物包裹，通过吻合将内脏血管直接重新附着于移植物上的开口。在体感诱发电位监测的基础上，以类似方式重建第9胸椎和第4腰椎水平之间的肋间动脉和腰动脉对。大多数病例手术在部分股-股旁路及选择性腹腔干和肾动脉灌注辅助下进行。除1例患者外，所有患者术后存活，术后晚期过着正常生活。借助部分旁路进行移植物包裹是治疗累及内脏分支的胸腹主动脉瘤的有效技术。
