Yamashiro S, Sakata R, Nakayama Y, Ura M, Arai Y, Sugimoto A
Department of Cardiovascular Surgery, Kumanoto Chyuou Hospital, Japan.
Jpn J Thorac Cardiovasc Surg. 1998 Aug;46(8):737-42. doi: 10.1007/BF03217812.
A seventy one year-old woman, who had an arch and thoracoabdominal aortic aneurysm (type II according to Crawford classification) with ischemic heart disease, underwent a separate operation using the elephant trunk method. At first, she underwent the ascending aorta and arch replacement the with elephant trunk technique, and, underwent CABG simulutaneously utilizing the separate extra corporeal circulation and hypothermic circulatory arrest. The Chest and abdominal CT revealed the enlargement of abdominal aortic aneurysm 5 months after operation. The second operation was performed using Stoney's spiral opening method and the revasculization of spinal arteries (Th6, 7 and Th9) underwent the segmental aortic clamping to prevent spinal cord ischemia. Furthermore, the second operation was performed using selective perfusion to visceral arteries and F-F bypass for the prevention of visceral ischemia. Each flow rate by selective perfusion in major abdominal blanches was from 50 to 100 ml/min. Therefore, hepatorenal dysfunction and paraparesis did not occur after the second operation. It was suggested that the segmental aortic clamping and the selective perfusion to visceral arteries with F-F bypass may be effective to prevent the ischemia of the spinal cord and abdominal organs.
一名71岁女性，患有主动脉弓及胸腹主动脉瘤（根据Crawford分类为II型）并伴有缺血性心脏病，采用象鼻术进行了分期手术。首先，她接受了升主动脉和主动脉弓置换术并采用象鼻技术，同时利用单独的体外循环和低温循环停止进行冠状动脉旁路移植术（CABG）。胸部和腹部CT显示术后5个月腹主动脉瘤增大。第二次手术采用Stoney螺旋开口法，并对脊髓动脉（胸6、7和胸9）进行再血管化，通过节段性主动脉阻断以预防脊髓缺血。此外，第二次手术采用对内脏动脉进行选择性灌注以及F-F旁路以预防内脏缺血。在主要腹部分支中通过选择性灌注的每个流速为50至100毫升/分钟。因此，第二次手术后未发生肝肾功能障碍和截瘫。提示节段性主动脉阻断以及通过F-F旁路对内脏动脉进行选择性灌注可能对预防脊髓和腹部器官缺血有效。
