Kawashima Y, Shirakura R, Nakano S, Matsuda H, Taniguchi K, Kaneko M, Kawaguchi A T, Kadoba K, Matsuwaka R
Department of Surgery, Osaka University Medical School Fukushima, Japan.
Surgery. 1993 Jan;113(1):59-64.
To prevent aneurysm rupture, avoid pseudoaneurysm formation, and preserve intercostal arteries, a new procedure for repair of DeBakey type 3 dissecting aneurysm was developed. Since January 1977, 28 patients have undergone repair of type 3 dissecting aneurysm. Fifteen patients with type 3b underwent this new procedure (group 1) and 13 patients with type 3a dissecting aneurysm underwent segmental graft replacement (group 2). In group 1 a permanent axillofemoral bypass was placed on the right side. Next the intrathoracic false lumen was opened longitudinally, the entry was closed, and the aneurysmal wall was sutured around the true lumen as tightly as possible. The operative mortality rate was 20% in group 1 and 31% in group 2. One of 15 patients in group 1 died of operation-related causes, whereas three patients in group 2 died. There were six late deaths: three in group 1 and three in group 2. Paraplegia occurred in neither group 1 nor group 2. The mean diameter of the plicated descending aorta was 24.0 +/- 2.7 mm 3 months after surgery. No recurrence was detected in group 1. These results suggested that this new surgical technique for repair of type 3 dissection reduces the incidence of paraplegia and pseudoaneurysm formation.
为预防动脉瘤破裂、避免假性动脉瘤形成并保留肋间动脉，我们开发了一种新的手术方法来修复DeBakeyⅢ型夹层动脉瘤。自1977年1月以来，28例患者接受了Ⅲ型夹层动脉瘤修复术。15例Ⅲb型患者接受了这种新手术（第1组），13例Ⅲa型夹层动脉瘤患者接受了节段性人工血管置换术（第2组）。在第1组中，在右侧建立永久性腋股旁路。接下来，纵向打开胸内假腔，封闭入口，并尽可能紧密地围绕真腔缝合动脉瘤壁。第1组的手术死亡率为20%，第2组为31%。第1组15例患者中有1例死于手术相关原因，而第2组有3例患者死亡。有6例晚期死亡：第1组3例，第2组3例。第1组和第2组均未发生截瘫。术后3个月，折叠降主动脉的平均直径为24.0±2.7mm。第1组未检测到复发。这些结果表明，这种用于修复Ⅲ型夹层动脉瘤的新手术技术降低了截瘫和假性动脉瘤形成的发生率。
