弓部大動脈瘤術後の脳障害

金沢大学医薬保健研究域医学系Postoperative brain dysfunction was studied for 18 patients who survived more than 30 days after operations of aortic arch aneurysms. The operative procedures were graft replacement in 12 patients, resection with direct or patch closure in 3, and thromboexclusion in 3. Except for thromboexclusion, adjuncts were used: temporary bypass in 1, partial EPC (extracorporeal circulation) in 2, and selective cerebral perfusion during EPC in 12. As for intra-operative monitoring, the temporal artery blood pressures were more than 50 mmHg in all, but the electroencephalogram changed to flat wave just after clamping the aorta in one patient. Postoperative brain dysfunction occurred in 5 patients, including temporary loss of consciousness in 2, lasting loss of consciousness in 1, and paralysis with loss of consciousness in 2. Postoperative brain dysfunction occurred more often in old aged men with atherosclerotic aneurysms. Patients with temporary brain dysfunction had no remarkable change in CT scan, but patients with lasting brain dysfunction had low density areas. It is recommended to prevent this complication as follows: 1) pre-operative evaluation of cerebral vascular disorders, 2) gentle maneuver of atherosclerotic lesions, 3) bilateral cerebral perfusions and intra-operative monitorings, 4) intensive perioperative care of circulation and respiration.1

T4肺癌に対する一時バイパス法による大動脈合併切除術

金沢大学医薬保健研究域医学系Radical operation for T4 lung cancer is technically difficult. We report here 3 cases of T4N0M0 lung cancer involving aorta or left subclavian artery which was successfully operated on. We could carry out combined aortic resection more safely and speedy under the assistant devices, such as Anthrontube and Biomedicus Centrifugal Pump. Even T4 lung cancer having aortic invasion with N0 disease can be operated on and be expected long-term survival using these assistant devices.1