Livesay J J, Cooley D A, Ventemiglia R A, Montero C G, Warrian R K, Brown D M, Duncan J M
Ann Thorac Surg. 1985 Jan;39(1):37-46. doi: 10.1016/s0003-4975(10)62520-9.
Over the past twelve years, surgical treatment of descending thoracic aneurysms has been performed in 360 patients. Three different operative strategies were employed during resection to provide distal aortic perfusion by temporary bypass (Group 1, 75 patients) or shunt (Group 2, 22 patients) or to simplify the operative procedure with aortic cross-clamping alone (Group 3, 263 patients). The surgical results were determined primarily by patient-related and disease-related variables. Advanced age (older than 70 years), atherosclerotic cause, and emergency operation significantly increased the risks of early mortality and morbidity. The incidence of death (11.7%), paraplegia (6.5%), or renal failure (6%) was not reduced by the use of adjunctive perfusion, and bleeding complications increased significantly in Groups 1 and 2. Spinal cord injury was increased significantly by emergency operations, cross-clamp times exceeding 30 minutes, and extensive aneurysms (p less than 0.05). The risk of renal failure was increased by advanced age and atherosclerotic cause (p less than 0.05). With an experienced surgical team, the primary risks of descending thoracic aneurysmectomy are not influenced by the method of adjunctive perfusion, but are determined by patient factors such as the nature and extent of the aneurysm.
在过去的十二年中，对360例降主动脉瘤患者实施了外科治疗。在切除过程中采用了三种不同的手术策略，通过临时旁路（第1组，75例患者）或分流（第2组，22例患者）来提供远端主动脉灌注，或仅通过主动脉交叉钳夹来简化手术操作（第3组，263例患者）。手术结果主要由患者相关和疾病相关变量决定。高龄（70岁以上）、动脉粥样硬化病因和急诊手术显著增加了早期死亡和发病的风险。辅助灌注的使用并未降低死亡（11.7%）、截瘫（6.5%）或肾衰竭（6%）的发生率，并且第1组和第2组的出血并发症显著增加。急诊手术、交叉钳夹时间超过30分钟和广泛的动脉瘤显著增加了脊髓损伤的风险（p<0.05）。高龄和动脉粥样硬化病因增加了肾衰竭的风险（p<0.05）。有了经验丰富的手术团队，降主动脉瘤切除术的主要风险不受辅助灌注方法的影响，而是由患者因素决定，如动脉瘤的性质和范围。
