CAJ | 학술논문

目的总结外伤性主动脉破裂的救治经验.方法 2001年7月-2008年12月共收治17例外伤性主动脉破裂患者.其中1例因入院后1 h死于失血性休克未行手术治疗;9例施行开胸手术,在全身麻醉下双腔气管插管,体外循环采用股动静脉插管、心脏不停跳部分转流,转流时间35～139 min,主动脉阻断时间25～87 min.7例手术成功者中1例行主动脉直接修补,6例行人工血管置换.其余7例施行腔内修复术,在全身麻醉或局部麻醉下经右侧股总动脉入路将覆膜支架置放于主动脉破裂处.结果 1例未手术者死于失血性休克.开胸手术组7例治愈,2例死亡;手术时间100～180 min;7例治愈者均获得随访,随访时间2～6年,随访期内无死亡.腔内修复组7例全部治愈,手术时间50～70 min;7例均获得随访,随访时间3～14个月,随访期内无死亡.6例术后2～5个月复查CT见主动脉周围无造影剂外溢,主动脉周围血肿消失.结论腔内修复术治疗外伤性主动脉破裂安全、简单、效果明确.但选择开胸手术还是腔内修复术要根据患者合并多发伤的情况、医院的设备条件及术者的技术熟练程度来决定.
목적 총결외상성주동맥파렬적구치경험.방법 2001년7월-2008년12월공수치17예외상성주동맥파렬환자.기중1례인입원후1 h사우실혈성휴극미행수술치료;9례시행개흉수술,재전신마취하쌍강기관삽관,체외순배채용고동정맥삽관、심장불정도부분전류,전류시간35～139 min,주동맥조단시간25～87 min.7례수술성공자중1례행주동맥직접수보,6례행인공혈관치환.기여7례시행강내수복술,재전신마취혹국부마취하경우측고총동맥입로장복막지가치방우주동맥파렬처.결과 1례미수술자사우실혈성휴극.개흉수술조7례치유,2례사망;수술시간100～180 min;7례치유자균획득수방,수방시간2～6년,수방기내무사망.강내수복조7례전부치유,수술시간50～70 min;7례균획득수방,수방시간3～14개월,수방기내무사망.6례술후2～5개월복사CT견주동맥주위무조영제외일,주동맥주위혈종소실.결론강내수복술치료외상성주동맥파렬안전、간단、효과명학.단선택개흉수술환시강내수복술요근거환자합병다발상적정황、의원적설비조건급술자적기술숙련정도래결정.
Objective To summarize experiences in treatment of traumatic aortic rupture. Methods Between July 2001 and December 2008, 17 patients with acute traumatic aortic rupture were treated in our department. One patient died of hemorrhagic shock one hour after admission before opera-tion. Nine patients underwent thoracotomy under general anesthesia with double lumen endotracheal tube and normothermic femoral-femoral partial cardiopulmonary bypass, with bypass time for 35-139 minutes and aortic clamping time for 25-87 minutes. Successful operation was performed in seven patients inclu-ding one treated with simple repair and the other six with partial replacement of thoracic aorta with artifi-cial vascular graft. The other seven patients underwent endovascular repair and received stent grafts at the site of thoracic injury via right lilac-femoral artery under general or local anesthesia. Results One pa-tient free from operation was died of hemorrhagic shock. Of nine patients treated with thoracotomy, two patients died of hemorrhagic shock during operation and the other seven survived, with operation time ran-ging from 100 to 180 minutes. Seven survivors were followed-up for 2-6 years, with no death during fol-low-up period. Seven patients in endovascular repair group recovered, wiht operation time ranging from 50 to 70 minutes. All these seven patients were followed up for 3-14 months, which showed no death. Reex-amined CT in six patients showed no mediastinal hematoma or leakage of contrast medium from the aorta isthmus at 2-5 months after operation. Conclusions Endovascular repair is simple, safe and effective for traumatic aortic rupture. The selection of thoracotomy and endovascular repair is based on following conditions: the combined injuries of patients, the equipments of hospital and the skills of operators.