Murashita T, Yasuda K, Matsui Y, Shiiya N, Sasaki S, Sakuma M
Department of Cardiovascular Surgery, Hokkaido University School of Medicine, Japan.
Surg Today. 1997;27(4):368-72. doi: 10.1007/BF00941816.
A successful replacement of the aorta from the ascending aorta to the supraceliac abdominal aorta in one operation is herein reported. The patient was 66-year-old woman who had DeBakey type I chronic aortic dissection with a pre-disseminated intravascular coagulation (DIC) condition. The image diagnosis revealed a markedly enlarged false lumen with a narrow true lumen in the ascending aorta extending to the diaphragm level while below the diaphragm level, the aortic dilatation was mild. The operation was performed through both a thoracoabdominal incision and a median sternotomy to expose the whole thoracic aorta, and the aorta was replaced from the ascending aorta to the supraceliac abdominal aorta. Selective cerebral perfusion was used for cerebral protection and this was a useful adjunct since no time limitations were thus required during repair of the aortic arch. Although the patient developed several complications postoperatively, she eventually recovered and was discharged from the hospital without any neurological disorders.
本文报道了一例在一次手术中成功地将主动脉从升主动脉替换至腹腔动脉上方腹主动脉的病例。患者为一名66岁女性,患有DeBakey I型慢性主动脉夹层,并伴有血管内凝血(DIC)前期症状。影像学诊断显示,升主动脉内假腔明显扩大,真腔狭窄,病变延伸至膈肌水平,而膈肌以下水平主动脉扩张较轻。手术通过胸腹联合切口和正中胸骨切开术进行,以暴露整个胸主动脉,并将主动脉从升主动脉替换至腹腔动脉上方腹主动脉。采用选择性脑灌注进行脑保护,这是一种有效的辅助手段,因为在修复主动脉弓时无需时间限制。尽管患者术后出现了多种并发症,但最终康复出院,无任何神经功能障碍。