Gu K, Nakayama K, Saitoh Y, Nosaka S, Sasaki T, Yamauchi M, Yamada K, Minami K
First Department of Surgery, Shimane Medical University, Izumo, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1996 Sep;44(9):1749-52.
Since 1982, fourteen patients with aortic aneurysms received thromboexclusion operation. This method was performed in 7 patients with dissecting aortic aneurysms, 6 patients with true thoracic aneurysms, and 1 patient with true thoracoabdominal aneurysm. Among them, 12 patients received the operation of ascending aorta-supraceliac abdominal aorta bypass, one patient received descending aorta-descending aorta bypass, and another one received bilateral axillo-iliac artery bypass. Graft sizes in diameter were from 16 mm to 22 mm. 9 patients received permanent paired-clamps at both the proximal and the distal parts of the thoracic aneurysm, and 5 patients received permanent single-clamp only at the proximal part of the thoracic aneurysm. 5 patients (35.7%) died perioperatively because of low output syndrome, cerebral infarction, hepato-renal insufficiency, and aneurysmal rupture, respectively. 4 late deaths (28.6%) occurred after 4 months, 5 months, 26 months, and 5 years of operation, respectively. Among them, three deaths were due to aneurysmal rupture and one due to heart failure. Although paired-clamps at both the proximal and the distal parts of the thoracic aneurysm were performed in 1 to 3 ruptured-cases, thrombo-occlusion of the thoracic aorta did not occur in any of the cases. Long-term survival was 35.7% in 5 patients after 14 years and 4 months of mean follow-up. Although a single-clamp only at the proximal part of the thoracic aneurysm was performed in 2 of these 5 cases, thrombo-occlusion of the thoracic aorta occurred in all cases. For the four survivors of them, we ran a follow-up survey and found left ventricular hypertrophic pattern in ECG, concentric left ventricular hypertrophy in UCG, and hypertension, but those were absent before operation. We conclude that thromboexclusion method for thoracic aneurysm should be limited only to high-risk patients particularly in bad conditions or to cases with severe adhesion to lung which seem to be inaccessible through direct approach.
自1982年以来，14例主动脉瘤患者接受了血栓排除手术。该方法应用于7例主动脉夹层动脉瘤患者、6例真性胸主动脉瘤患者和1例真性胸腹主动脉瘤患者。其中，12例患者接受了升主动脉-腹腔干上腹部主动脉旁路手术，1例患者接受了降主动脉-降主动脉旁路手术，另1例患者接受了双侧腋-髂动脉旁路手术。移植血管直径为16毫米至22毫米。9例患者在胸主动脉瘤近端和远端均使用了永久性双钳夹，5例患者仅在胸主动脉瘤近端使用了永久性单钳夹。5例患者（35.7%）分别因低心排血量综合征、脑梗死、肝肾衰竭和动脉瘤破裂在围手术期死亡。4例晚期死亡（28.6%）分别发生在术后4个月、5个月、26个月和5年。其中，3例死亡归因于动脉瘤破裂，1例归因于心力衰竭。尽管在1至3例破裂病例中对胸主动脉瘤近端和远端均使用了双钳夹，但所有病例均未发生胸主动脉血栓形成。平均随访14年4个月后，5例患者的长期生存率为35.7%。尽管这5例患者中有2例仅在胸主动脉瘤近端使用了单钳夹，但所有病例均发生了胸主动脉血栓形成。对其中4例幸存者进行随访调查，发现心电图呈左心室肥厚型，超声心动图显示左心室向心性肥厚，且有高血压，但术前无这些情况。我们得出结论，胸主动脉瘤的血栓排除方法应仅限于高危患者，特别是病情较差的患者或与肺严重粘连、似乎无法通过直接手术方法处理的病例。
