腸管虚血合併Stanford A型急性大動脈解離に対する上腸間膜動脈バイパス術

Open Superior Mesenteric Artery Bypass for Stanford Type A Acute Aortic Dissection with Mesenteric Malperfusion

腸管虚血合併Stanford A型急性大動脈解離（AMI）はいまだ予後不良である．その理由はほかの臓器障害に比べ治療介入の適応，時期が確立されていないことにある．われわれはこれまでの経験から，現在CT所見を唯一の判断材料として上腸間膜動脈（SMA）バイパス術を先行して行っており，その取り組みについて報告する．

The optimal management of Stanford type A acute aortic dissection with mesenteric malperfusion （AMI） is controversial. Our strategy of AMI is open superior mesenteric artery （SMA） bypass prior to aortic repair, if we suspect AMI on computed tomography （CT） scan, whatever other findings might be or not. The need of treatment of mesenteric malperfusion prior to aortic repair is not always concerned with digestive symptom, lactate, intraoperative finding. The mortality was 15.8％, which was an allowable result. Our strategy might be proper at instances of, allowable time for management of open SMA bypass, unnecessarily of endovascular treatment, confirming an enteric property and ability to respond to various rapid hemodynamic changes.