CAJ | 학술논문

目的总结钝性外伤后胸主动脉扩张性病变诊疗经验.方法回顾性分析12例钝性外伤后胸主动脉扩张性病变的临床资料,其中主动脉夹层(Stanford B型)8例以及降主动脉假性动脉瘤4例.术前螺旋CT血管造影及术中数字血管减影造影对病变进行评估,待严重合并症稳定后行腔内支架型人工血管植入术.术后3、6、12个月以及其后每年随访CTA明确治疗效果.结果 11例行腔内支架型人工血管植入术,另1例未及手术死亡.所有手术患者均获技术成功,完全或部分遮蔽左锁骨下动脉6例,支架释放后即刻造影发现内漏3例,2例球囊扩张后内漏消失,1例仅给予随访.共9例获随访(B型主动脉夹层6例、降主动脉假性动脉瘤3例),均正常生存,未出现左上肢缺血症状及神经系统阳性体征,CTA检查示近远端主动脉无新发夹层或动脉瘤,无内漏、截瘫以及支架移位等并发症.结论钝性外伤后胸主动脉损伤多位于主动脉峡部,待重要脏器合并症稳定后行腔内支架型人工血管治疗有效可行,安全性高.
목적 총결둔성외상후흉주동맥확장성병변진료경험.방법 회고성분석12례둔성외상후흉주동맥확장성병변적림상자료,기중주동맥협층(Stanford B형)8례이급강주동맥가성동맥류4례.술전라선CT혈관조영급술중수자혈관감영조영대병변진행평고,대엄중합병증은정후행강내지가형인공혈관식입술.술후3、6、12개월이급기후매년수방CTA명학치료효과.결과 11례행강내지가형인공혈관식입술,령1례미급수술사망.소유수술환자균획기술성공,완전혹부분차폐좌쇄골하동맥6례,지가석방후즉각조영발현내루3례,2례구낭확장후내루소실,1례부급여수방.공9례획수방(B형주동맥협층6례、강주동맥가성동맥류3례),균정상생존,미출현좌상지결혈증상급신경계통양성체정,CTA검사시근원단주동맥무신발협층혹동맥류,무내루、절탄이급지가이위등병발증.결론 둔성외상후흉주동맥손상다위우주동맥협부,대중요장기합병증은정후행강내지가형인공혈관치료유효가행,안전성고.
Objective To sum up the experience in treating thoracic aortic aneurysmal disease caused by blunt injury.Methods From September 2003 to March 2009,12 Patients were admitted into our center due to thoracic aortic aneurysmal disease after blunt injury,including 8 Stanford type B aortic dissections and 4 descending aorta pseudoaneurysms.Diagnosis was established by CT angiography and re-evaluated by angiography before endovascular treatment. Once severe co-morbidity due to iniury wag stabilized,endovascular repair of the lesions Was carried out with stent-graft implantation.Follow.up was done by CTA at 3 months、6 months、1 year and then annually postoperatively.Results Eleven patients underwent endovascular surgery,while 1 died before intervention.Technical success was achieved in all patients with left subclavian artery intentionally covered in 6 cases.Endoleak Was observed in 3 cases andmanaged with balloon dilation in 2 easels.9 cases were followed up without mortality,including 6 disseetions and 3 pseudoaneurysms.No ischemic symptom of left uppar extremity or positive neurological sign or paralysis were observed,CTA revealed no newly-developed dissection or aneurysm、no endoleak or stent migration. Conclusion Thoracic aortic aneurysmal disease after blunt injury mostly locates in aortic isthmus;endovascular stent-graft implantation after stabilization of concurrent disease is effective.