创伤性主动脉破裂的外科治疗经验

Surgical Experiences for Traumatic Aortic Rupture

目的回顾分析创伤性主动脉破裂的临床特征,总结外科治疗的经验和效果。方法自2003年1月~2013年6月华中科技大学同济医院心胸外科46例创伤性主动脉破裂患者接受外科治疗,12例患者在体外转流下行开放手术,其中5例行主动脉修补,7例行主动脉置换;34例患者行主动脉腔内修复术,完全或部分覆盖左锁骨下动脉4例,其中1例行锁骨下动脉转流术。结果 12例行开放性手术患者平均手术时间（125.6±24.2）min,平均住院时间为（25.6±14.5）d,住院期间死亡2例。34例行主动脉腔内修复手术患者平均手术时间（60.2±10.5）min,平均住院时间为（14.5±7.6）d,住院期间死亡2例。术中造影发现内漏2例,行球囊扩张贴附后内漏消失,随访1~5年内无截瘫、内漏、左上肢缺血、支架移位等并发症。结论创伤性主动脉破裂一旦明确诊断,应尽早手术治疗,主动脉腔内修复术已逐渐取代开放性手术成为外科治疗的首选。

Objective To retrospectively analyze the clinical characteristics of traumatic aortic rupture and summarize the surgical experiences of this disease.Methods Forty-six consecutive patients with traumatic aortic rupture received surgical treatment in Tongji Hospital between Jan.2003 and Jun.2013.Twelve patients underwent open surgical repair with the aid of partial cardiopulmonary bypass,including five treated with thoracic aortic repair and the rest seven with partial replacement of thoracic aorta with artificial vascular graft.Thirty-four patients were subjected to endovascular aortic repair.Complete or partial cover of left subclavian artery was performed in four patients,with revascularization in only one case.Results The mean operation time was（125.6±24.2）min,the average hospital stay was（25.6±14.5）days and two patients died during hospitalization in 12 patients who received open surgical repair.In the patients（n=34）receiving endovascular aortic repair,the mean operation time was（60.2±10.5）min,the average hospital stay was（14.5±7.6）days and death occurred in two patients during hospitalization.Operative angiography revealed endoleak in two patients,which disappeared after balloon dilation.During a follow-up period of 1to 5years,no complications,such as paralysis,endoleak,ischemia of left upper extremity or stent-graft migration,occurred.Conclusion Traumatic aortic rupture should be surgically treated as early as possible after diagnosis.Endovascular aorta repair has substituted open surgery and become the treatment of choice for traumatic aortic rupture.