钝性外伤性主动脉损伤的治疗策略选择

The choice of treatment strategies of major arteries injury caused by blunt force

目的探讨钝性外伤性主动脉损伤的手术治疗时机和治疗策略选择对术后恢复影响。方法回顾收治的主动脉损伤患者16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。结果钝性外伤性主动脉损伤患者16例中,减速伤11例,摩托车外伤1例,高空坠落伤2例,腹部挤压伤1例,胸部震荡伤1例;2例胸部CT平扫,14例CT血管成像(CTA)确诊;胸降主动脉损伤14例,腹主动脉损伤2例;胸降主动脉损伤行腔内修复术12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1例,2例患者未及治疗死亡。结论钝性外伤性主动脉损伤患者术前应通过CTA检查进行明确诊断,结合主动脉损伤的程度、合并损伤尤其是脑损伤评估治疗时机与方法,采用腔内修复手术仍是目前治疗主动脉损伤的最佳方案。

Objective To investigate the choice of surgical opportunity and treatment strategies in treatment of major arteries damage caused by blunt force,and to explore its effects on postoperative recovery.Methods The clinical data about 16 patients with major arteries injury caused by blunt force who were admitted and treated in our hospital from October 2007 to December 2016 were retrospectively analyzed.The diagnosis methods,choice of surgical opportunity,surgical methods and treatment outcome were analyzed.Results Among 16 patients with major arteries injury caused by blunt force,there were 11 cases of deceleration injury.1 case of motorcycle external injury,2 cases of high-altitude falling injury,1 case of abdominal crush injury,1 case of chest concussion injury.Moreover 2 patients were definitely diagnosed by plain CT scan,14 patients were definitely diagnosed by CT angiography.In addition there were 14 cases of descending thoracic aorta injury,2 cases of abdominal aorta injury.Besides 12 patients with descending thoracic aorta damage were treated by endovascular repair(EVR),1 patient with abdominal aorta damage was treated by abdominal prosthesis replacement,1 patients with abdominal aorta dissection was followed-up and 2 patients died before treatment.Conclusion The patients with major arteries damage caused by blunt force should be examined by CTA to diagnose definitely before operation,and it is necessary to evaluate surgical opportunity and method by considering major artery injury degree and merging injuries,especially brain injury.At present endovascular repair(EVR)is still the best scheme in treatment of major arteries injury.