University of Louisville, Department of Surgery, Louisville, KY 40201, USA.
J Am Coll Surg. 2012 Jun;214(6):943-9. doi: 10.1016/j.jamcollsurg.2012.03.003. Epub 2012 Apr 26.
Thoracic endovascular aneurysm repair (TEVAR) has been a major advance in the treatment of blunt thoracic aortic injury (BTAI), although many patients still undergo open repair. This study was undertaken to evaluate outcomes with open repair and TEVAR for BTAI.
A retrospective review of all patients with BTAI at a single Level I trauma center from 2001 through 2009 was performed. Patients were grouped according to treatment modality, ie, open repair, TEVAR, or medical management. Direct comparison using standard statistical methods was made between patients undergoing open repair and TEVAR since late 2006 when TEVAR began at our institution using standard statistical methods. Outcomes variables included mortality, paraplegia, length of stay, ICU stay, and ventilator requirements.
There were 69 patients in the study, with 36 (52.2%) undergoing open repair, 10 receiving TEVAR (14.5%), 10 patients managed medically (14.5%), and 13 (18.8%) who died during triage. Overall mortality in the pre-TEVAR era was 29.6%. Since the introduction of TEVAR, there have been 8 open repairs. Patients undergoing open repair were significantly younger (32 vs 58 years; p = 0.002) and had smaller aortic diameter (18 mm vs 24.5 mm; p < 0.001) than those undergoing TEVAR. Overall mortality since the introduction of TEVAR has dropped to 12.0% (p = 0.097).
TEVAR and open repair should be viewed as complementary rather than competing modalities for the treatment of BTAI. Having both available allows selection of the most appropriate management technique for each patient, with subsequent improvement in outcomes.
胸主动脉血管内修复术（TEVAR）在治疗钝性胸主动脉损伤（BTAI）方面取得了重大进展，尽管仍有许多患者需要进行开放性修复。本研究旨在评估开放性修复和 TEVAR 治疗 BTAI 的效果。
对一家一级创伤中心 2001 年至 2009 年所有 BTAI 患者进行回顾性研究。根据治疗方式将患者分为开放修复、TEVAR 和药物治疗三组。自 2006 年底我们医院开始采用标准方法进行 TEVAR 治疗以来，使用标准统计方法对接受开放修复和 TEVAR 的患者进行了直接比较。观察指标包括死亡率、截瘫、住院时间、重症监护病房（ICU）住院时间和呼吸机使用需求。
本研究共纳入 69 例患者，其中 36 例（52.2%）接受了开放性修复，10 例接受了 TEVAR（14.5%），10 例接受了药物治疗（14.5%），13 例（18.8%）在分诊过程中死亡。TEVAR 治疗前总体死亡率为 29.6%。自 TEVAR 引入以来，共进行了 8 例开放性修复。与接受 TEVAR 治疗的患者相比，接受开放性修复的患者更年轻（32 岁比 58 岁；p = 0.002），主动脉直径更小（18 毫米比 24.5 毫米；p < 0.001）。TEVAR 引入后，总体死亡率已降至 12.0%（p = 0.097）。
TEVAR 和开放性修复应被视为治疗 BTAI 的互补而非竞争手段。两种方法都具备可以使我们为每位患者选择最合适的治疗方法，从而改善治疗效果。
