Fehrenbacher J W, McCready R A, Hormuth D A, Beckman D J, Halbrook H G, Herod G T, Pittman J N, Siderys H
Cardiovascular Surgical Associates, Methodist Hospital of Indiana, Indianapolis 46202.
J Vasc Surg. 1993 Sep;18(3):366-70; discussion 370-1.
The purpose of this study is to describe a technique for resection of extensive thoracoabdominal aneurysms, which the authors believe will lower morbidity and mortality rates.
In an effort to minimize the risk of spinal cord ischemia, we have used a combination of sided heart bypass (left atrium to left femoral artery) with local cooling of the intercostal and visceral arteries and segmental resection of the aneurysm. Segmental resection of the aneurysm allows perfusion of the spinal cord and abdominal viscera as the proximal anastomosis is completed and as each pair of intercostal arteries is reimplanted. An attempt is made to reimplant all pairs of intercostal arteries from T8 to L2. Before the intercostal or visceral arteries are reimplanted, that segment of aorta is cooled with cold crystalloid solution. Thus no segment of the aorta is exposed to warm ischemia for more than 30 minutes. Left-sided heart bypass allows the patient's temperature to be maintained between 35 degrees C and 37 degrees C.
We have used this technique in 23 patients with types I and II (Crawford's classification) thoracoabdominal aneurysms. Seven patients (30%) had dissections or rupture associated with their aneurysms and underwent emergency operation. One of these seven patients became paraplegic after operation, for a 4.3% incidence of paraplegia. One patient died of multiple organ failure after operation. No patient had kidney failure requiring dialysis.
We believe that our technique allows the operation to be performed in a deliberate manner with a low incidence of paraplegia and kidney failure.
本研究的目的是描述一种用于广泛胸腹主动脉瘤切除的技术，作者认为该技术将降低发病率和死亡率。
为了尽量减少脊髓缺血的风险，我们采用了侧心转流（左心房至左股动脉）联合肋间动脉和内脏动脉局部降温以及动脉瘤节段性切除的方法。动脉瘤节段性切除可在完成近端吻合以及每对肋间动脉重新植入时，为脊髓和腹部脏器提供灌注。尝试重新植入从T8至L2的所有肋间动脉对。在肋间动脉或内脏动脉重新植入之前，用冷晶体溶液对该段主动脉进行降温。因此，主动脉的任何节段暴露于温暖缺血状态的时间均不超过30分钟。左侧心转流可使患者体温维持在35℃至37℃之间。
我们已将该技术应用于23例I型和II型（克劳福德分类法）胸腹主动脉瘤患者。7例（30%）患者的动脉瘤伴有夹层或破裂，接受了急诊手术。这7例患者中有1例术后发生截瘫，截瘫发生率为4.3%。1例患者术后死于多器官功能衰竭。无患者发生需要透析的肾衰竭。
我们认为我们的技术能够以谨慎的方式进行手术，且截瘫和肾衰竭的发生率较低。
