Nzewi O, Slight R D, Zamvar V
Department of Cardiothoracic Surgery, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK.
Eur J Vasc Endovasc Surg. 2006 Jan;31(1):18-27. doi: 10.1016/j.ejvs.2005.06.031. Epub 2005 Oct 14.
Blunt traumatic aortic transection (TAT) is an uncommon injury in clinical practice that is associated with a high morbidity and mortality. The approach to patients with such an injury is controversial with specific regard to the most effective diagnostic tools, timing of surgical intervention and mechanisms of spinal cord protection. Chest X-ray with widening of the mediastinum is unreliable as a diagnostic tool. Contrast enhanced helical CT Scan has replaced the traditional angiography as the screening diagnostic tool of choice Emergency thoracotomy and repair should be reserved for the few patients with isolated TAT without any major concomitant injuries. Delayed management approach with aggressive blood pressure control and serial radiological monitoring is a safe and recommended option for those with severe concomitant injuries or other medical co-morbidity that puts surgery at high risk. Active augmentation of the distal perfusion pressure during cross clamp offers the best protection against development of paraplegia during open surgical repair. Endovascular stenting offers a minimally invasive method of treatment but the long-term durability of the endovascular stent is still unknown. We feel that the greater feasibility of the endovascular repair in the acute phase of the thoracic injury is an advantage over the open surgery and should be the treatment of choice in patients with severe concomitant injuries.
钝性创伤性主动脉横断（TAT）在临床实践中是一种不常见的损伤，其发病率和死亡率都很高。对于此类损伤患者的治疗方法存在争议，具体涉及最有效的诊断工具、手术干预时机以及脊髓保护机制。胸部X线显示纵隔增宽作为诊断工具并不可靠。对比增强螺旋CT扫描已取代传统血管造影成为首选的筛查诊断工具。急诊开胸手术和修复应仅用于少数单纯TAT且无任何严重合并伤的患者。对于那些有严重合并伤或其他使手术风险很高的内科合并症的患者，采用积极控制血压和系列影像学监测的延迟处理方法是一种安全且推荐的选择。在开放手术修复过程中，在阻断时积极提高远端灌注压能为预防截瘫提供最佳保护。血管内支架置入提供了一种微创治疗方法，但血管内支架的长期耐用性仍不明确。我们认为，在胸部损伤急性期血管内修复的更大可行性是相对于开放手术的一个优势，应成为有严重合并伤患者的首选治疗方法。
