| Japanese |
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| Title | Stanford A型急性大動脈解離に対する治療戦略 |
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| Subtitle | 症例 |
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| Authors | 汐口壮一*, 吉田成彦**, 加藤一平** |
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| Organization | *獨協医科大学附属越谷病院心臓血管外科, **新葛飾病院心臓血管外科 |
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| Journal | 循環制御 |
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| Volume | 28 |
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| Number | 1 |
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| Page | 64-68 |
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| Year/Month | 2007/3 |
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| Article | 報告 |
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| Publisher | 日本循環制御医学会 |
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| Abstract | 「要旨」急性大動脈解離に対する術式選択は分類, entry存在部位など病態により様々で議論があるところである. 当科では緊急手術においてA型急性大動脈解離に対し主として上行, 部分弓部大動脈置換術を施行してきた. 治療戦略と経験に関し検討結果を報告する. 「対象」2000年11月〜2004年1月の間に経験したA型急性大動脈解離症に緊急手術を施行した38症例を対象とした. 男女比20:18. 平均年齢63.2±11.4歳(40〜87歳). 上行大動脈置換術施行11症例. 上行, 弓部部分置換術25症例. 上行, 弓部置換術2症例. 「方法」基本的方針として送血は鎖骨下動脈を選択. 循環停止時は直腸温20℃を目標とし右鎖骨下動脈送血時は一側順行性脳還流, 左鎖骨下動脈送血時は逆行性脳還流を施行とする. 同時に大腿動脈も確保した. 「結果」上行, 弓部部分置換は4例死亡(術前破裂にて心停止2例, 術前LMT閉塞によるAMI 1例, 術前内頚動脈閉塞による広範囲脳梗塞1例), 脳梗塞発症1症例. 半身麻痺症例1例. 両側鎖骨下動脈に解離が進行し送血が大腿動脈のみとなった1症例を経験した. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | stanford aortic dissection, hemiarch replacement, emergency surgery |
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| English |
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| Title | Strategy of Surgical Procedure for Stanford A Type Acute Aortic Dissection |
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| Authors | Soichi Shioguchi*, Ippei Kato**, Shigehiko Yoshida** |
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| Organization | *Department of Cardiovascular Surgery Koshigaya Hospital Dokkyo University School of Medicine, **Department of Cardiovascular Surgery, Shinkatushika Hospital |
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| Journal | Circulation Control |
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| Volume | 28 |
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| Number | 1 |
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| Page | 64-68 |
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| Year/Month | 2007/3 |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | We reviewed our therapeutic strategies and experience for acute type A aortic dissection. The subjects were 38 patients who underwent the emergency surgery for type A aortic dissection during the period from November 2000 to January 2004. Their mean age was 63.2±11.4 years (range 40〜87 years). The subjects were classified into the following three groups according to surgical procedures: replacement of the ascending aorta (n=11), replacement of the hemiarch aorta (n=25) and replacement of the total arch of aorta (n=2). As a rule, the subclavian artery was selected for blood transmission. The target rectal temperature at the time of circulatory arrest was 20℃. Unilateral anterograde brain perfusion was performed perfusion through the right subclavian artery, while retrograde brain perfusion was performed through the superior vena cava. The femoral artery was simultaneously ensured. Four of those who underwent replacement of the hemiarch aorta died. The 34 patients who had no major complications before surgery were discharged from the hospital and 33 of them succeeded in social rehabilitation. There was no significant difference in surgical factors and incidence of cerebral infarction between replacement of the heimiarch aorta and the ascending aorta. As acute emergency surgery for type A aortic dissection, replacement of the hemiarch aorta including isolated brain perfusion seems to be less invasive than replacement of the total arch aorta. |
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| Practice | Basic medicine |
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| Keywords | stanford aortic dissection, hemiarch replacement, emergency surgery |
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