钝性外伤性主动脉损伤的诊断及治疗策略的选择  

Choice of diagnosis and therapeutic strategy of the blunt traumatic aortic injury

作　　者：何庚戌[1] 刘俊堂[2] 濮仁富[1] 蔡宝松[1] 赵雷 张雁[1] 孙永杰[1] HE Geng-xu;LIU Jun-tang;PU Ren-fu;CAI Bao-song;ZHAO Lei;ZHANG Yah;SUN Yong-jie(Department of Thoracic and Cardiovascular Surgery;Department of Anesthesiology,PEA 251 Hospital,Zhangjiakou 075000,Hebei,China)

机构地区：[1]解放军第251医院胸心血管外科,河北张家口075000 [2]解放军第251医院麻醉科,河北张家口075000

出　　处：《心脏杂志》2018年第6期708-712,共5页Chinese Heart Journal

摘　　要：目的探讨钝性外伤性主动脉损伤的诊断、手术治疗时机和治疗策略的选择。方法总结主动脉损伤患者17例(其中胸主动脉损伤15例、腹主动脉损伤2例)的诊疗过程,分析其诊断方法、手术时机的选择、手术方法,以及治疗结果。结果 17例钝性外伤性主动脉损伤患者中,12例减速伤,1例为摩托车外伤,高空坠落伤2例,腹部挤压伤1例,胸部震荡伤1例;从受伤到确诊时间6 h～15 d,2例胸部CT平扫确诊,15例CT血管成像(CTA)确诊;胸降主动脉15例,腹主动脉损伤2例; 13例胸降主动脉损伤行腔内修复术,1例腹主动脉损伤患者行开腹人工血管置换术,1例腹主动脉夹层随访观察,2例患者未及治疗死亡。结论钝性外伤性主动脉损伤可以通过CTA明确诊断,应根据患者主动脉损伤的程度、并发损伤尤其是脑损伤选择合适的治疗时机,腔内修复手术是目前治疗胸降主动脉损伤的最佳治疗手段。AIM To investigate the diagnosis, optimal time to intervention and operation strategy of blunt traumatic aortic injury. METHODS The present investigation reviewed diagnosis, time of operation, and strategy of operation of 17 patients with blunt traumatic aortic injury between October 2007 and December 2016. Among the 17 patients, 15 sustained blunt thoracic aortic injuries distal to the origin of the left subclavian artery and 2 patients sustained blunt abdominal aorta injuries. RESULTS The injuries included car collisions （12 cases）, motor collision （1 case）, high falls （2 eases）, abdominal crush （1 case） and repeated chest strikes by cable drilling tools （1 case）. The diagnoses were made from 6 hours to 15 days after injury. Thirteen patients received thoracic endovascular repair, 1 patient received abdominal aorta replacement with a ＂Y＂ branched artificial vascular repair, 1 patient with abdominal aortic aneurysm was followed up, and 2 patients died without operation. CONCLUSION Blunt traumatic aortic injury is easily diagnosed using computer tomography angiography （CTA）. The optimal time of operation should be decided according to aorta injury degree, combined with injury and secondary signs of the injury. Thoracic endovascular repair may be the optimal choice for the thoracic aorta injuries distal to the origin of left subclavian artery.

关 键 词：钝性外伤性主动脉损伤 计算机断层血管成像 血管腔内主动脉修复术 

分 类 号：R543.1[医药卫生—心血管疾病]