Miyagi K, Koja K, Kuniyoshi Y, Iha K, Akasaki M, Shimoji M, Kugai T, Kamada Y, Oomine Y, Kusaba A
Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1993 Oct;41(10):2054-8.
Revascularization of the spinal arteries with thoracic aortic aneurysm were performed on nineteen patients using partial extracorporeal bypass. They were 16 men and 3 women. Age range were from 33 to 70 years (mean 49.9 +/- 10.3 years). There were eleven patients of dissecting aneurysm (DeBakey type IIIb in eight patients, type I in two patients and type IIIa in one patient), and eight patients of non-dissecting thoracoabdominal aneurysm (including two patients with ruptured aneurysm). The number of revascularized spinal arteries were 60 pairs (average 3.2 pairs per each patient). The revascularized spinal arteries were localized between levels T4 and L5.36 pairs of the 60 existed between levels T8 and L2 from where the artery of Adamkiewicz arises. Seven patients (eleven spinal arteries) underwent selective angiography of the revascularized spinal arteries postoperatively, and the anterior spinal artery and the artery of Adamkiewicz was identified in three patients. Two patients died within one month, one from MOF and the another from intestinal perforation respectively (operative mortality 11.1%). One patient, with ruptured thoracoabdominal aortic aneurysm showed paraparesis postoperatively, but no paraplegia was found in any patients. We recommend that not only the artery of Adamkiewicz but also the spinal arteries at the midthoracic area from T4 to T8 should be revascularized, to prevent postoperative paraplegia. Replacing of extended thoracic aneurysm, our method (using partial extracorporeal circulation and segmental aortic clamping) was thought to prevent spinal cord ischemia.
对19例患有胸主动脉瘤的患者采用部分体外循环进行脊髓动脉血运重建。其中男性16例，女性3例。年龄范围为33至70岁（平均49.9±10.3岁）。有11例为夹层动脉瘤（8例为DeBakey IIIb型，2例为I型，1例为IIIa型），8例为非夹层胸腹主动脉瘤（包括2例动脉瘤破裂患者）。脊髓动脉血运重建的数量为60对（平均每位患者3.2对）。血运重建的脊髓动脉位于T4至L5水平之间。60对中有36对位于Adamkiewicz动脉发出的T8至L2水平之间。7例患者（11条脊髓动脉）术后接受了血运重建脊髓动脉的选择性血管造影，3例患者中识别出了脊髓前动脉和Adamkiewicz动脉。2例患者在1个月内死亡，1例死于多器官功能衰竭，另1例死于肠穿孔（手术死亡率11.1%）。1例胸腹主动脉瘤破裂患者术后出现轻瘫，但未发现任何患者出现截瘫。我们建议不仅要对Adamkiewicz动脉进行血运重建，还要对T4至T8胸段中部的脊髓动脉进行血运重建，以预防术后截瘫。对于置换延长的胸主动脉瘤，我们的方法（采用部分体外循环和节段性主动脉阻断）被认为可预防脊髓缺血。
