儿童创伤性胸主动脉假性动脉瘤一例报道及文献复习

Traumatic aortic injury in children： case report and literature review

目的探讨创伤导致的儿童胸腹主动脉损伤的诊疗方法，以增加大家对这种临床罕见病的认识。方法报道1例4岁女孩的创伤性胸主动脉瘤的诊断及治疗，并通过PubMed检索Medline数据库、检索SpringerLink和GoogleScholar等检索平台、及Embase、Ovid、中国生物医学文献数据库（CBM）、中国知网（CNKI）、万方和维普数据库，对儿童创伤性胸腹主动脉损伤的中英文文献进行系统性的综述。结果一共43例年龄在14岁以下的创伤性胸腹主动脉损伤的患儿纳入本研究。交通伤26例是最常见的致伤机制。7例（16．3％）患儿伤后未及时诊断或初诊时漏诊。6例患儿随访中存在不同程度的后遗症。主动脉损伤以假性动脉瘤（20例）最常见，其次为内膜剥离（7例）及主动脉夹层（7例）。27例患儿行开放主动脉修复术，7例行血管内治疗，7例患儿保守治疗，2例患儿行急诊手术，并在围手术期死亡。结论血流动力学不稳或主动脉完全破裂的患儿需要急诊手术。而主动脉内膜环形剥离患儿发生并发症的可能性较高，需要限期手术。没有明显症状的内膜部分剥离或是迟发型假性动脉瘤的患儿可以保守治疗，但需要密切观察，如果假性动脉瘤进展，则需要手术。

Objective To report one case of traumatic aortic injury and review the literature for better understanding the natural history and management of this rare injury. Methods One case was reported in 2015. Medline, Springer Link and Google Scholar were searched for the relevant publications using a combination of text words and search terms. English and Chinese academic databases of Embase, Ovid, CBM, CNKI and CQVIP were also searched with a review of references in retrieved publications. Results A total of 41 children aged 16-168 months were included. Motor vehicle crash was a leading cause of injury （n = 26）. Six patients had residual sequelae. The major primary aortic lesions were pseudoaneurysm （48. 8%）, intimal transection （26. 8%） and aortic dissection （14. 6%）. The interventions included aortic repair （n = 27）, endovascular repair （n = 7） and non-surgical approaches （n = 7）. Two patients died during or after an emergent abdominal exploratioru Conclusions Symptomatic lesions and complete rupture should be surgically repaired immediately. Circumferential intimal transection has such a high risk of complications that it should be managed in stages. Partial intimal transection and delayed pseudoaneurysm may be initially observed by clinical examination and imaging. Patients with any sign of deterioration should be operated.