CAJ | 학술논문

目的探讨对胸主动脉钝性创伤(blunt traumatic thoracic aortic injury,BTTAI)病灶的影像学分型,考量其分型对手术选择的参考价值. 方法 BTTAI共12例,按CT显示主动脉损害局部病灶的轮廓分为三型:A型,主动脉血管轮廓形态正常而管腔内有内膜片游离；B型,轮廓异常且造影剂渗漏到主动脉管腔外但局限于纵隔内；C型,轮廓异常且造影剂渗漏到胸腔.结合全身ISS、局部损害位置、手术救治方式、患者结局等信息,对分型价值进行探讨. 结果 12例均为全身多发伤合并BTTAI,其主动脉病灶影像均可被上述分型所概括.BTTAI的病灶影像:A型3例,B型7例,C型2例,验证假性动脉瘤为最常见BTTAI.各型BTTAI的ISS、低血压率、救治方式或死亡率差异均无统计学意义. 结论 BTTAI多见于多发伤,总体伤情的评估并不限于主动脉局部病灶类型.本病灶分型反映血管壁损害程度,结合病灶位置和毗邻关系(特别是锚碇区的长度),对手术决策具有明确的参考价值.
목적 탐토대흉주동맥둔성창상(blunt traumatic thoracic aortic injury,BTTAI)병조적영상학분형,고량기분형대수술선택적삼고개치. 방법 BTTAI공12례,안CT현시주동맥손해국부병조적륜곽분위삼형:A형,주동맥혈관륜곽형태정상이관강내유내막편유리；B형,륜곽이상차조영제삼루도주동맥관강외단국한우종격내；C형,륜곽이상차조영제삼루도흉강.결합 전신ISS、국부손해위치、수술구치방식、환자결국등신식,대분형개치진행탐토. 결과 12례균위전신다발상합병BTTAI,기주동맥병조영상균가피상술분형소개괄.BTTAI적병조영상:A형3례,B형7례,C형2례,험증가성동맥류위최상견BTTAI.각형BTTAI적ISS、저혈압솔、구치방식혹사망솔차이균무통계학의의. 결론 BTTAI다견우다발상,총체상정적평고병불한우주동맥국부병조류형.본병조분형반영혈관벽손해정도,결합병조위치화비린관계(특별시묘정구적장도),대수술결책구유명학적삼고개치.
Objective To discuss imaging classification of blunt traumatic thoracic aortic injury (BTTAI) and weigh guideline value of its imaging classification to surgical options.Methods BTTAI in 12 patients were divided into three types in accordance with outline of aortic injury revealed by CT imaging,i.e.,type A of normal outline of aortic blood vessel but free endothelium in aortic cavity,type B of abnormal aortic outline and contrast extravasation to aortic lumen exterior but only confining to mediastina,and type C of abnormal aortic outline and contrast leakage to thoracic cavity.Significance of BTTAI morphological classification was analyzed according to data,such as systemic injury severity score (ISS),local injury sites,surgical approaches and patients' outcome.Results Multiple injuries combined with BTTAI were observed in all patients whose aortic lesion image could be all generalized by above-mentioned classification.BTTAI image showed type A in three patients,type B in seven and type C in two.Pseudoaneurysm was confirmed as the foremost common BTTAI.There were no significant differences in ISS,hypotension morbidity,treatment methods or mortality between each type of BTTAI.Conclusions BTTAI occurs mostly in multiple injuries and thus overall injury severity assessment is not only depended on aortic lesion classification.BTTAI classification in this study reflects injury severity of vessel wall,takes account to location of lesion and adjacent relations (especially length of landing zone) and hence has accurate referential value for surgical decisions.