创伤性Stanford B型主动脉夹层腔内治疗4例临床分析

Thoracic endovascular aortic repair of traumatic type B aortic dissection:a report of four cases and review of literatures

目的探讨急性创伤性Stanford B型主动脉夹层的临床诊断和治疗的经验,评估TEVAR治疗创伤性Stanford B型主动脉夹层的安全性和有效性。方法回顾性分析2015年5月至2019年12月浙江大学医学院附属邵逸夫医院心脏大血管外科收治的4例创伤性Stanford B型主动脉夹层患者的临床资料,其中男性2例,女性2例;中位年龄42岁(范围:31~82岁)。致伤原因包括交通事故3例,高处坠落伤1例。4例患者均出现胸腔积液,其他临床表现有四肢骨折3例,双侧多发肋骨骨折3例,肱二头肌肌腱撕裂1例,眼球破裂1例。发病至住院中位时间8.5 h(范围:5~11 h)。结果4例患者均行TEVAR手术,术后均未见心肾功能衰竭、脑梗死、截瘫等并发症,术后1周顺利出院。出院3个月后复查CTA,均未见内漏、支架移位、夹层进展等并发症。结论TEVAR治疗创伤性Stanford B型主动脉夹层手术时间短、创伤小、恢复快、死亡率低,短期随访效果良好。

Objective To discuss the clinical diagnosis and treatment of traumatic type B aortic dissection(TBAD)and evaluate the safety and effectiveness of thoracic endovascular aortic repair(TEVAR)for traumatic TBAD.Methods The clinical data of 4 patients with traumatic TBAD from May 2015 to December 2019 were analyzed retrospectively in Sir Run Run Shaw Hospital of Zhejiang University School of Medicine.Men accounted for 50%.The median age was 42 years(range:31-82 years).Underlying causes were traffic accident(3 cases)and high falling(1 case).Clinical manifestations included pleural effusion(4 cases),limb fractures(3 cases),bilateral rib fractures(3 cases),torn biceps tendon(1 case)and eyeball rupture(1 case).The median time from onset to hospitalization was 8.5 hours(range:5-11 hours).Results All 4 patients were treated by TEVAR.No complications of heart or kidney failure,cerebral infarction or paraplegia were reported.All patients were discharged from hospital 1 week after operation.CTA showed that no complications of endoleakage,stent migration and aortic dissection progression occurred on the follow-up period of 3 months.Conclusion TEVAR is an effective method for the treatment of traumatic TBAD with shorter operative time,less trauma,rapid recovery and low mortality rate.And the short-term follow-up results are satisfactory.