Journal of Chest Surgery

  • 제37권6호
  • /
  • Pages.517-523
  • /
  • 2004
  • /
  • 2765-1606(pISSN)
  • /
  • 2765-1614(eISSN)
대한심장혈관흉부외과학회 (The Korean Society for Thoracic and Cardiovascular Surgery)
권호 표지

급성 Type A 대동맥 박리에서 내막 파열의 위치에 따른 수술 성적의 분석

Clinical Analysis of the Operative Results of the Type A Aortic Dissection according to the Location of the Intimal Tear

  • 김혁 (한양대학교 의과대학 흉부외과학교실) ;
  • 정기천 (한양대학교 의과대학 흉부외과학교실) ;
  • 지행옥 (한양대학교 의과대학 흉부외과학교실) ;
  • 강정호 (한양대학교 의과대학 흉부외과학교실) ;
  • 정원상 (한양대학교 의과대학 흉부외과학교실) ;
  • 이철범 (한양대학교 의과대학 구리병원 흉부외과학교실) ;
  • 전순호 (한양대학교 의과대학 구리병원 흉부외과학교실) ;
  • 김영학 (한양대학교 의과대학 흉부외과학교실)
  • Kim, Hyuck (Dept. of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University) ;
  • Chung, Ki-Chun (Dept. of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University) ;
  • Jee, Heng-Ok (Dept. of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University) ;
  • Kang, Jung-Ho (Dept. of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University) ;
  • Chung, Won-Sang (Dept. of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University) ;
  • Lee, Chul-Bum (Dept. of Thoracic and Cardiovascular Surgery, Kuri Hospital, College of Medicine, Hanyang University) ;
  • Chon, Soon-Ho (Dept. of Thoracic and Cardiovascular Surgery, Kuri Hospital, College of Medicine, Hanyang University) ;
  • Kim, Young-Hak (Dept. of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University)
  • 발행 : 2004.06.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

배경: 급성 type A 대동맥 박리에서 내막 파열의 위치는 다양할 수 있다. 본 연구에서는 내막 파열의 위치에 따른 수술 성적을 분석하였다. 대상 및 방법: 1995년 1월부터 2003년 5월까지 급성 type A 대동맥 박리로 수술받은 18명의 환자에서 내막 파열이 상행대동맥에 존재했던 경우(Group I, 11명)와 대동맥궁이나 하행대동맥에 위치하거나 대동맥 벽 내 혈종 (intramural hematoma)만이 있었던 경우(Group II, 7명)로 나누어 술 전, 술 중 소견, 수술 방법, 합병증, 사망 원인을 후향적으로 분석하였다. 결과: 수술 시간, 체외순환 시간, 대동맥 차단 시간 및 순환 정지 시간은 Group I에서 각각 381.5$\pm$81.0분, 223.5$\pm$42.5분, 146.4$\pm$34.8 분, 36.5$\pm$17.4분이었고, Group II에서는 각각 461.7$\pm$54.0분, 252.5$\pm$45.3분, 162.5$\pm$45.3분, 47.0$\pm$14.4분으로 Group II에서 더 길었다. 전체적으로 5명이 사망하여 27.8%(5/18)의 사망률을 나타냈으며 Group I에서는 9.1% (1/11), Group II에서는 57.1% (4/7)로 Group II에서 통계적으로 유의하게 높았다(p=0.003). 사망 원인으로는 출혈이 Group I에서 1명, Group II에서 2명, 저심박출 및 다발성 장기 기능 부전 1명, 술 후 복부대동맥 파열 1명이었다. 결론: 내막 파열이 상행 대동맥에 존재하는 type A 대동맥 박리에서의 수술 사망률은 크게 높지 않으나 내막 파열이 대동맥궁부 또는 하행대동맥에 위치했을 때 상행대동맥만을 대치한 경우 아직 높은 사망률을 나타내고 있다. 따라서 향후 수술 성적의 향상을 위해서는 내막 파열 부위를 수술 범위에 포함시키는 노력이 필요할 것으로 생각한다.

Background: The location of intimal tear can vary in type A acute aortic dissection. The aim of this study was to assess the operative result according to the intimal tear site. Material and Method: From January, 1995 to May, 2003, 18 patients underwent surgery for acute type A aortic dissection. The patients were classified according to the intimal tear site. In Group I (n=11), the intimal tear site was located within the ascending aorta, in Group II (n=7), the intimal tear site was located in the aortic arch, descending aorta, or intramural hematoma only. All clinical data were analyzed retrospectively. Result: In Group I, the operative time, cardiopulmonary bypass time, aorta cross clamp time and circulatory arrest time were 381.5$\pm$81.0 min, 223.5$\pm$42.5 min, 146.4$\pm$34.8 min and 36.5$\pm$17.4 min, respectively; and in group II, 461.7$\pm$54.0 min, 252.5$\pm$45.3 min, 162.5$\pm$45.3 min and 47.0$\pm$14.4 min respectively. All of those were greater in group II. The overall hospital mortality rate was 27.8% (5/18) and was significantly higher in Group II (57.1%)(p=0.003) compared to that in Group I (9.1%). The causes of death were hemorrhage (n=1) in group I and hemorrhage (n=2), multiple organ failure (n=1), and rupture of abdominal aorta (n=1) in group II. Conclusion: Surgical treatment of acute type A aortic dissection with intimal tear in the ascending aorta results in an acceptable mortality rate, but in patients with intimal tear in the aortic arch or descending aorta, the operative mortality still remains high when only ascending aorta replacement was performed. In these circumstances, in order to improve surgical results, efforts to include the intimal tear site in the operative procedure will be needed.

키워드

참고문헌

  1. Circulation v.56 The evolution of medical and surgical management of acute aortic dissection Wolfe,W.C.;Moran,J.F.
  2. J Thorac Cardiovasc Surg v.96 Replacement of the transverse aortic arch during emergency operation for type A acute aortic dissection Bachet,J.;Teodori,G.;Goudot,B.(et al.)
  3. Ann Thorac Surg v.50 Aortic dissection with the entrance tear in transverse aorta: analysis of 12 autopsy patients Roberts,C.S.;Roberts,W.C. https://doi.org/10.1016/0003-4975(90)90681-U
  4. J Thorac Cardiovasc Surg v.104 Surgery for acute dissection of ascending aorta. Should the arch be included? Crawford,E.S.;Kirklin,J.W.;Naftel,D.C.;Svensson,L.G.;Cosell,J.S.;Safi,H.J.
  5. J Thorac Cardiovasc Surg v.78 Operative treatment of aortic dissection : esperience with 125 patients over a sixteen-year period Miller,D.C.;Stinson,E.B.;Oyer,P.E.(et al.)
  6. Ann Thorac Surg v.58 Total arch graft replacement in patients with acute type A aortic dissection Kazui,T.;Kimura,N.;Yamada,O.;Komatsu,S. https://doi.org/10.1016/0003-4975(94)91936-4
  7. Ann Thorac Surg v.50 Excision of the aortic wall in the surgical treatment of acute type A aortic dissection Massimo,C.G.;Presenti,L.F.;Favi,p.p.(et al.) https://doi.org/10.1016/0003-4975(90)90748-U
  8. Eur J Cardiothorac Surg v.21 Retrograde extension of type B dissetion after endovascular stent graft repair [Letter] Urbanski,P.P.
  9. Radiology v.170 Natural history of the false channel of type A aortic dissection after surgical repair-CT study yamaguchi,T.;Guthener,D.F.;Wexler,L. https://doi.org/10.1148/radiology.170.3.2916028
  10. Ann Thorac Surg v.57 Significance of distal false lumen after type A aortic dissection repair Ergin,L.A.;Phillips,R.A.;Galla,J.D.(et al.) https://doi.org/10.1016/0003-4975(94)90182-1
  11. Ann Thorac Surg v.75 Ascending aorta replacement and local repair of tear site in type A aortic dissection with arch tear Park,K.H.;Sung,K.;Kim,K.M.(et al.) https://doi.org/10.1016/S0003-4975(03)00170-X
  12. Ann Thorac Surg v.44 Operative management of acute aortic dissection usingprofound hypothermia and surculatory arrest Graham,J.M.;Stinnett,D.M. https://doi.org/10.1016/S0003-4975(10)62040-1
  13. J Card Surg v.17 Brain protection during surgery of the aortic arch Bachet,J.;Guilmet,D. https://doi.org/10.1111/j.1540-8191.2002.tb01185.x
  14. Euro J Cardiothorac Surg v.6 Deep hypothermic systemic circulatory arrest and continuous retrograde cerebral perfusion for surgery of aortic arch anuerysm Ueda,Y.;Miki,S.;Kusuhara(et al.) https://doi.org/10.1016/1010-7940(92)90096-G
  15. J Thorac Cardiovasc Surg v.102 Cold cerebroplegia: A new technique of cerebral protection during operation on the transverse aortic arch Bachet,J.;Guilmet,D.;Goudot,B.(et al.)
  16. Ann Thorac Surg v.67 Surgery for acute type A aortic dissection David,T.E.;Armstrong,S.;Ivanov,J.;Barnard,S. https://doi.org/10.1016/S0003-4975(99)00353-7