Yamane Brett H, Tefera Girma, Hoch J R, Turnipseed W D, Acher C W
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
Surgery. 2008 Oct;144(4):575-80; discussion 580-2. doi: 10.1016/j.surg.2008.06.007. Epub 2008 Aug 29.
Despite a lack of level I evidence, endovascular stent grafting is frequently used for the treatment of blunt thoracic aortic injury. The purpose of this study is to compare the outcomes between open and endovascular repair of traumatic rupture of the thoracic aorta.
This article is based on a single-institution review of all consecutive patients treated for blunt aortic injury at the University of Wisconsin Hospital and Clinics between October 1999 and May 2007. This study was reviewed and approved by the institutional review board. Patients were identified from our Level 1 trauma registry. Inclusion criteria for this study was based on computed tomographic or angiographic evidence of thoracic aortic injury distal to the left subclavian artery. Two groups were identified: patients who underwent open repair (OR) and, patients who underwent endovascular repair (ER). Patient demographics, mechanism of injury, Injury Severity Score, associated injuries, comorbid conditions, intraoperative findings, postoperative complications, and duration of hospital stay were analyzed. Data regarding these patients and their injuries were retrieved from our trauma registry as well as chart review and outpatient records. The outcomes from OR and ER were compared using the Fisher exact test. P values less than 0.05 were considered statistically significant.
During the 8-year period, 26 consecutive patients were treated for blunt aortic injury (OR = 12 and ER = 14). There were 20 men, and the mean age was 36 years. There were no differences between the groups in the mechanism of injury, Injury Severity Score, or number of associated injuries on initial presentation. On an intent-to-treat basis, the endovascular therapy was technically successful 100% of the time. There was no procedure-related mortality. There was 1 patient, however, in the OR group with presumed recurrent laryngeal nerve palsy. There was no incident of treatment-related paraplegia in either group. The 1-year survival for OR and ER patients was 93% and 92%, respectively. At 1 year, 25% of patients in the OR group and 18% of patients in the ER group required reinterventions. Mean operating room time was 309 minutes for the ERs and 383 minutes for the patients who underwent OR. Intraoperative blood product administration was greater in the OR group (P = .055); there was no difference between the groups, however, in the total blood products administered for a given hospital stay. The mean duration of hospital stay was 13 days for the OR group and 13.9 days for the ER group.
There were no significant differences with respect to morbidity or mortality between these 2 groups. These data suggest that ER is at least as safe as OR for blunt aortic injury.
尽管缺乏一级证据，但血管内支架植入术仍经常用于治疗钝性胸主动脉损伤。本研究的目的是比较开放性手术和血管内修复术治疗胸主动脉创伤性破裂的疗效。
本文基于对1999年10月至2007年5月间在威斯康星大学医院及诊所接受钝性主动脉损伤治疗的所有连续患者的单机构回顾。本研究经机构审查委员会审查并批准。患者从我们的一级创伤登记处识别。本研究的纳入标准基于左锁骨下动脉远端胸主动脉损伤的计算机断层扫描或血管造影证据。确定了两组：接受开放性修复（OR）的患者和接受血管内修复（ER）的患者。分析了患者的人口统计学特征、损伤机制、损伤严重程度评分、相关损伤、合并症、术中发现、术后并发症及住院时间。有关这些患者及其损伤的数据从我们的创伤登记处以及病历审查和门诊记录中获取。使用Fisher精确检验比较OR和ER的结果。P值小于0.05被认为具有统计学意义。
在8年期间，连续26例患者接受了钝性主动脉损伤治疗（OR组12例，ER组14例）。有20名男性，平均年龄为36岁。两组在损伤机制、损伤严重程度评分或初次就诊时相关损伤数量方面无差异。在意向性治疗的基础上，血管内治疗在技术上100%成功。无手术相关死亡。然而，OR组有1例患者疑似喉返神经麻痹。两组均无治疗相关截瘫事件。OR组和ER组患者的1年生存率分别为93%和92%。1年后，OR组25%的患者和ER组18%的患者需要再次干预。ER组的平均手术时间为309分钟，OR组患者为383分钟。OR组术中血液制品输注量更大（P = 0.055）；然而，两组在给定住院期间输注的总血液制品量方面无差异。OR组的平均住院时间为13天，ER组为13.9天。
这两组在发病率或死亡率方面无显著差异。这些数据表明，对于钝性主动脉损伤，ER至少与OR一样安全。
