腸管虚血を伴う急性A型大動脈解離に対する1治験例  [in Japanese] A Successful Surgical Repair for Mesenteric Ischemia Associated with Acute Type A Dissection  [in Japanese]

症例は65歳,女性.胸背部痛,右下肢痛を自覚し近医受診した.腹痛増強し当院搬送となった.造影CT上,上行大動脈基部より右総腸骨動脈まで解離し偽腔は開存,上行大動脈径は48mmであった.上腸間膜動脈(SMA)も解離し真腔は血栓化した偽腔により圧迫され閉塞していた.心エコー上大動脈弁閉鎖不全はtrivialで心嚢液は認めず,循環動態は安定していたが腹痛持続し,腸管壊死の危険性を考慮し緊急的に開腹した.腸管壊死は認めなかったが色調は蒼白で,大伏在静脈による左外腸骨動脈-SMAバイパスを施行した.術後鎮静化降圧療法を行い2日後上行弓部置換を施行した.腹部症状消失し術後46日後に独歩退院となった.

A 65-year-old woman presented to a local hospital with chest, back and right leg pain. She was transferred to our hospital because her abdominal pain gradually increased. CT scan demonstrated an acute type A aortic dissection from the proximal ascending aorta to the right common iliac artery, with a 48mm diameter in the ascending aorta. The proximal superior mesenteric artery (SMA) was completely occluded by the thrombosed false lumen. Echocardiography showed minor aortic regurgitation, and no pericardial effusion. Her hemodynamics were stable, but abdominal pain persisted. Emergency laparotomy, performed because of mesenteric infarction with intestinal necrosis, provided no evidence of any intestinal necrosis. She underwent left external iliac artery to distal SMA bypass with a saphenous vein graft, because the intestine looked pale. Then the total arch replacement was performed two days later. The patient's postoperative course was uneventful, and her abdominal symptom completely disappeared.