Symbas P N, Hunter R M, Vlasis S E, Ansley J D
Ann Thorac Surg. 1986 Jun;41(6):647-51. doi: 10.1016/s0003-4975(10)63080-9.
Two patients, each with an infected descending thoracic aortic fistula, are described. The first patient had a postpneumonitic empyema. Thoracostomy tube drainage resulted in obliteration of the empyema cavity. Upon slight withdrawal of the tube, 49 days after its insertion, massive pulsating bleeding occurred through the sinus tract. The bleeding was controlled with manual pressure at the entry site of the chest tube, and the patient was operated upon immediately. A descending aortic defect, 3 cm long X 1.5 cm wide, at the site of the thoracostomy tube was primarily closed. Ten months after the surgical procedure, the patient has had no difficulty referable to her aortic erosion. In the second patient, 9 months after removal of the T-10 vertebra (which had a large cell tumor) and replacement of the vertebra with Dunn's metallic device, hemoptysis and left lower lobe consolidation developed. Aortography demonstrated a lobulated false aneurysm, 4 cm wide X 6 cm long, at the site of Dunn's device. A 16-mm graft was sutured end to side to the descending aorta just distal to the left subclavian artery and to the abdominal aorta below the renal arteries. The false aneurysm was then removed, the two ends of the aorta were sutured, and the stumps were covered with omental graft. Nine months after the repair the patient has had no difficulty referable to the aortic surgery.
本文描述了两名患有降主动脉瘘感染的患者。第一名患者患有肺炎后脓胸。胸腔闭式引流术使脓腔闭塞。在置管49天后，稍微拔出引流管时，窦道出现大量搏动性出血。在胸管置入部位用手按压控制住出血，患者立即接受手术。胸腔闭式引流管置入部位有一个3厘米长×1.5厘米宽的降主动脉缺损，予以一期缝合。手术十个月后，患者未出现与主动脉侵蚀相关的问题。第二名患者在切除患有大细胞瘤的T10椎体并用邓恩金属装置置换椎体9个月后，出现咯血和左肺下叶实变。主动脉造影显示在邓恩装置置入部位有一个4厘米宽×6厘米长的分叶状假性动脉瘤。在左锁骨下动脉远端将一段16毫米的移植物端端缝合至降主动脉，并在肾动脉下方缝合至腹主动脉。然后切除假性动脉瘤，缝合主动脉两端，残端用网膜移植物覆盖。修复术后九个月，患者未出现与主动脉手术相关的问题。
