创伤外科杂志2024,Vol.26Issue(3) :175-182.DOI:10.3969/j.issn.1009-4237.2024.03.004

创伤性主动脉损伤单中心临床诊治经验

Management of traumatic aortic injuries:a single-center experience

刘畅 宋毅 袁烨 丁任重 吴文军 田现钢 钟昌明 陈建明 胡义杰
创伤外科杂志2024,Vol.26Issue(3) :175-182.DOI:10.3969/j.issn.1009-4237.2024.03.004

创伤性主动脉损伤单中心临床诊治经验

Management of traumatic aortic injuries:a single-center experience

刘畅 1宋毅 1袁烨 1丁任重 1吴文军 1田现钢 1钟昌明 1陈建明 1胡义杰1
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作者信息

  • 1. 陆军军医大学大坪医院心脏血管外科,重庆 400042
  • 折叠

摘要

目的 观察创伤性主动脉损伤(TAI)治疗的近远期疗效.方法 回顾性分析2013年2月-2023年1月陆军军医大学大坪医院心脏血管外科救治的12例TAI患者的诊治情况.其中男性11例,女性1例;年龄27~80岁,平均51.7岁;道路交通伤8例,撞击伤2例,高处坠落伤2例.收集并分析患者主动脉损伤的分型、特点、治疗策略,多发伤治疗情况以及近远期随访结果.结果 主动脉损伤患者中,Stanford A型主动脉夹层2例,Stanford B型主动脉夹层8例,Stanford Non-A/B型主动脉夹层2例;接受主动脉手术者8例(66.7%),其中急诊手术5例,择期手术3例.体外循环下开放手术治疗3例,胸主动脉腔内修复术(TE-VAR)4例,杂交手术1例,非手术治疗4例.开放手术和杂交手术患者均治愈,无围术期死亡.TEVAR治疗患者中,1例合并严重多发伤,住院期间死亡.4例非手术治疗患者住院期间存活.随访时间14~123个月,平均45.9个月.截至2023年6月最后一次随访,1例TEVAR治疗患者失访,余10例患者均存活,无新发主动脉事件.结论 早期识别TAI,充分评估患者的多发伤及主动脉损伤伤情,制定个性化整体治疗方案,合理地干预和正确的手术策略,是TAI治疗成功的关键.

Abstract

Objective To observe the short-and long-term treatment outcomes of traumatic aortic injuries(TAI).Methods A retrospective analysis was performed on 12 TAI cases managed in the Department of Cardio-vascular Surgery,Daping Hospital,Army Medical University,from Feb.2013 to Jan.2023.Among them,there were 11 males and 1 female aged 27-80(mean 51.7)years.The injury causes were road traffic accidents in 8 cases,im-pact in 2,and falls from height in 2.The classification,characteristics and treatment strategies of TAI,treatment of multiple injuries,and short-and long-term outcomes of patients were collected and analyzed.Results In this case series of TAI,there were 2 Stanford type A aortic dissection,8 Stanford type B,and 2 Stanford Non-A/B.Among them,66.7%(8/12)underwent aortic surgery,including 5 emergency and 3 selective surgeries:respectively 3 open surgeries under cardiopulmonary bypass,4 thoracic endovascular aortic repair(TEVAR),and 1 hybrid surgery.The other 4 cases had non-surgical treatment.The 3 patients with open surgeries and the patient with hybrid surgery sur-vived and recovered well.As for the 4 patients with TEVAR,1 had severe multiple injuries and died during hospital-ization.The 4 non-surgically treated patients survived to discharge.Patients were followed up for 14-123(mean 45.9)months.Up to the last follow-up in June 2023,1 patient with TEVAR was lost to follow-up,and the remaining 10 patients were all alive without any new aortic events.Conclusion Early identification of TAI,comprehensive evaluation of TAI and associated injuries,personalized treatment plans,and appropriate intervention or surgical strat-egies are the keys to successful management of such patients.

关键词

创伤性主动脉损伤/多发伤/主动脉夹层/胸主动脉腔内修复术

Key words

Traumatic aortic injury/Multiple injuries/Aortic dissection/Thoracic endovascular aortic re-pair

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基金项目

重庆市科卫联合医学科研项目(2018ZDXM003)

出版年

2024
创伤外科杂志
第三军医大学,大坪医院,野战外科研究所

创伤外科杂志

CSTPCD
影响因子:1.017
ISSN:1009-4237
参考文献量19
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