Emergency thoracoabdominal aortic aneurysm repair: Clinical outcome
Emergency thoracoabdominal aortic aneurysm repair: Clinical outcome
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DOI：
10.1016/s0022-5223(99)70185-6
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发表时间：
1999-09-01
影响因子：
6
通讯作者：
Chello, M
中科院分区：
文献类型：
--
作者：
Mastroroberto, P;Chello, M
目的：胸腹主动脉瘤急诊修补术是一项高发病率、高死亡率的手术。尽管先进的手术和围手术期护理技术降低了选择性修复这些动脉瘤的风险，但急诊手术的死亡率仍然很高。方法：1993年1月至1998年9月，连续47例胸腹主动脉瘤患者，其中19例需要紧急手术治疗。12例动脉瘤破裂，7例急性夹层。诊断出ⅰ型胸腹主动脉瘤12例，ⅱ型3例，ⅲ型1例，ⅳ型3例（Crawford’s）。所有患者均经胸开腹并行部分股股体外循环手术。监测脑脊液压力，用血管移植物代替主动脉，可行时再植未闭肋间动脉。结果：早期（30 d）死亡率为42.1%；有2人晚死。11例存活患者并发症总结如下：截瘫/截瘫3例；肾脏4例；肺部4例；心脏1例；脑血管1例；再次探查出血1例。血液透析和主动脉夹层是住院死亡率的预测因素。结论：尽管住院死亡率为42.1，但我们急诊修复胸腹主动脉瘤的手术经验在后期结果方面必须被认为是令人鼓舞的。%，存活患者术后并发症严重。此外，我们的结果表明，急性主动脉夹层和需要血液透析是死亡率的预测因素。
Objective: Emergency repair of thoracoabdominal aortic aneurysm remains a formidable operation with high morbidity and mortality. Although advanced surgical and perioperative care techniques have reduced the risks in elective repair of these aneurysms, the mortality rate has remained high when emergency surgery is performed. We have evaluated the outcome of patients undergoing emergency repair of thoracoabdominal aortic aneurysm, Methods: Of 47 consecutive patients with thoracoabdominal aortic aneurysm observed from January 1993 to September 1998, 19 required an emergency operation. Twelve had a ruptured aneurysm and 7 an acute dissection. Twelve type I, 3 type II, 1 type III, and 3 type IV thoracoabdominal aortic aneurysms (Crawford's classification) were diagnosed, All patients were operated on via a thoracolaparotomy with partial femoral-femoral extracorporeal circulation. The cerebrospinal fluid pressure was monitored, and the aorta was replaced with a vascular graft, Patent intercostal arteries were reimplanted when feasible. Results: The early (30-day) mortality was 42.1%; there were 2 late deaths. Complications in the 11 surviving patients are summarized as follows: paraplegia/paraparesis, 3 cases; renal, 4 cases; pulmonary, 4 cases; cardiac, 1 case; cerebrovascular, 1 case; and reexploration for bleeding, 1 case. Hemodialysis and aortic dissection were predictive factors of hospital mortality. Conclusions: Our surgical experience in emergency repair of thoracoabdominal aortic aneurysm must be considered encouraging in terms of late outcome despite the in-hospital mortality of 42.1.% and serious postoperative complications in the surviving patients. Moreover, our results show that acute aortic dissection and the need for hemodialysis are predictive factors for mortality.