tailieunhanh - Surgical complications - part 4

là từ động mạch đốt sống và lan toả (đoạn chi nhánh của động mạch chủ ngực và bụng). Trong phân đoạn của nó thấp hơn tủy sống phụ thuộc vào các động mạch lan toả. Các động mạch lan toả rất lớn (động mạch Adamkiewicz) thường có mặt tại | 282 J. Chikwe T Athanasiou is from vertebral and radicular arteries segmental branches of the thoracic and abdominal aorta . In its lower segments the spinal cord depends on the radicular arteries. The great radicular artery artery of Adamkiewicz usually present at T12 L2 frequently provides the entire arterial supply for the lower two-thirds of the cord. Strategies to minimise the risk of spinal cord ischaemia include surgical techniques hypothermia intraoperative cerebrospinous fluid withdrawal and pharmacological adjuncts. Most surgeons attempt to preserve and reimplant large radicular arteries particularly below T10. Some surgeons monitor the somatosensory and motor evoked potentials SSEP and MEP respectively which provide a better indication of the anterior cord function clamping intercostals vessels sequentially and dividing them only if no change in SSEP is seen after 10 min of clamping. It is important to minimise the ischaemic time by maintaining perfusion of vessels downstream of the distal graft anastomosis and by preventing hypotension. Whole body hypothermia offers some protection to ischaemic injury. The most important principle is the reduction of spinal cord temperature during the ischaemic period surface and intrathecal cooling have been used in addition to whole body cooling. Intraoperative withdrawal of cerebrospinous fluid is designed to increase perfusion pressure of the cord by increasing the difference between intracramial and arterial pressures. There is little evidence to support this technique which also runs the important risk of intrathecal bleeding leading to paraparesis. Pharmacological adjuncts include corticosteroids sodium thiopental prostaglandin E and a variety of oxygen free radical scavengers. These are not used routinely as they have not shown any significant difference in the outcome. 3. COMPLICATIONS OF THORACIC SURGERY Complications of Lung Resection for Malignancy Death and recurrence The operative mortality for lung .