创伤性主动脉损伤的外科治疗策略

目的总结创伤所致主动脉损伤的外科治疗策略。方法纳入2009年1月至2018年1月北京安贞医院心血管外科治疗的34例创伤性主动脉损伤患者(交通肇事伤31例、坠落伤2例、物体砸伤1例)。男23例,女11例。患有高血压病10例,胸主动脉假性动脉瘤9例,胸主动脉离断6例,主动脉夹层共19例。开放手术5例,年龄(44.80±20.57)岁;2例A型主动脉夹层行Bentall+孙氏手术,1例B型夹层及2例胸主动脉假性动脉瘤行术中支架人工血管置入术。胸主动脉腔内修复术29例,年龄(45.93±11.01)岁。结果开放手术时间(403.20±30.30)min,患者住院(19.00±6.04)天;胸主动脉腔内修复术手术时间(105.72±27.76)min,患者住院(5.76±3.08)天。所有患者术后随访(45.09±23.10)个月,两组均无死亡,2例胸主动脉腔内修复术患者因封闭左锁骨下动脉未开通而出现左上肢乏力麻木。结论创伤性主动脉损伤应根据患者全身情况、损伤等级、损伤累及部位及解剖特点来选择不同的治疗方案。但远期预后仍有待确定。

Surgical treatment strategy for traumatic aortic injury

Objective To summarize the surgical treatment strategy for aortic injury caused by trauma.Methods From January 2009 to January 2018,34 patients with TAI were treated in Beijing Anzhen Hospital.10 had hypertension.23 cases were males.There were 31 cases caused by traffic accidents,2 cases were fall injuries,and 1 case was bruise.9 cases were thoracic aortic pseudoaneurysm,6 cases were thoracic aorta,and 19 cases were aortic dissection.29 patients underwent TEVAR and 5 patients underwent OR(2 patients with type A aortic dissection undergoing Bentall+Sun's procedure,1 patient with type B aortic dissection and 2 patients with thoracic aortic pseudoaneurysm undergoing stented elephant trunk procedure).Results The follow-up time was(45.09±23.10)months.The mean age of patients undergoing OR or TEVAR was(44.80±20.57)years old,(45.93±11.01)years old;the mean operation time was(403.20±30.30)minutes,(105.72±27.76)minutes;the mean hospitalization(19.00±6.04),(5.76±3.08)days.There were no deaths in the two groups.2 patients uundergoing TEVAR had left upper limb numbness.Conclusion The treatment of patients with TAI should be based on the general condition,the classification of injury,the involving regions and anatomical features to choose different treatments.In addition,the long-term prognosis of patients remains to be determined.