Kamohara K, Sakata R, Ueyama K, Nakayama Y, Ura M, Arai Y
Department of Cardiovascular Surgery, Kumomoto-chuou Hospital, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1997 May;45(5):783-6.
A 33-year-old male was admitted to our hospital because of mediastinal bleeding by the traffic accident. He was in shock state. Chest roentgenogram showed widening of the upper mediastium, massive pleural effusion and deviation trachea to right. Chest CT scan showed left hemothorax and deviated mediastinum to right. Immediately after the end of the CT scan, the pulse of bilateral femoral artery was not palpable. Therefore, we started cardiac massage and carried to the operation room in a hurry. Under cardiac massage, median sternotomy was made. But, there were no abnormal findings in the ascending aorta and arch. Under ECC, left anterolateral incision was added. We found that the transection of the descending thoracic aorta was transversely without preservation of the adventitia and it reached a round of the aorta. Five cm of the descending aorta from just distal to the left subclavian artery was replaced with 22 mm Hemashield graft under the separate perfusion of upper and lower body and circulatory arrest. Postoperative course was stable and the patient was healthy at present.
一名33岁男性因交通事故导致纵隔出血入院。他处于休克状态。胸部X线片显示上纵隔增宽、大量胸腔积液以及气管向右偏移。胸部CT扫描显示左侧血胸和纵隔向右偏移。CT扫描结束后立即触摸不到双侧股动脉搏动。因此，我们开始进行心脏按压并匆忙将其送往手术室。在心脏按压下，进行了正中胸骨切开术。但升主动脉和主动脉弓未发现异常。在体外循环下，增加了左前外侧切口。我们发现胸降主动脉横断，外膜未保留，且累及主动脉环。在上下半身分别灌注和循环阻断下，用22mm的Hemashield人工血管替换了左锁骨下动脉远端5cm的胸降主动脉。术后病程平稳，患者目前健康。
