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[创伤性主动脉损伤的诊断与治疗]

[Diagnostics and treatment of traumatic aortic injuries].

作者信息

Benz R M, Makaloski V, Brönnimann M, Mertineit N, von Tengg-Kobligk H

机构信息

Diagnostische, Interventionelle und Pädiatrische Radiologie, Inselspital, Universität Bern, Freiburgstr. 18, 3010, Bern, Schweiz.

Universitätsklinik für Herz- und Gefäßchirurgie, Inselspital, Universität Bern, Freiburgstr. 18, 3010, Bern, Schweiz.

出版信息

Unfallchirurg. 2021 Aug;124(8):601-609. doi: 10.1007/s00113-021-01044-0. Epub 2021 Jul 12.

Abstract

BACKGROUND

Traumatic aortic injuries (TAI) are rare injuries in blunt thoracic trauma, which have a high morbidity and mortality. Rapid and accurate diagnosis as well as the correct choice of treatment are elementary for patient survival.

OBJECTIVE

Determination of the current standards for diagnostics of TAI in the acute trauma setting and evaluation of the current guidelines for treatment.

MATERIAL AND METHODS

A literature search was carried out for articles describing diagnostics of TAI. Furthermore, the guidelines for treatment and follow-up of TAI were summarized.

RESULTS

Despite the low specificity conventional chest X‑ray is still named in the literature as initial diagnostic procedure. Primarily, computed tomography (CT) should follow as the method of choice for diagnostics and treatment stratification due to the high sensitivity and specificity. Thoracic endovascular aortic repair (TEVAR) is recommended by all guidelines as first line treatment of higher grades of TAI (grades II-IV) and has replaced open surgery in most cases.

CONCLUSION

After rapid diagnosis and classification of TAI with CT, in most cases TEVAR has become the preferred treatment over open surgery.

摘要

背景

创伤性主动脉损伤(TAI)在钝性胸部创伤中较为罕见,但发病率和死亡率很高。快速准确的诊断以及正确的治疗选择是患者生存的基本要素。

目的

确定急性创伤情况下TAI的当前诊断标准,并评估当前的治疗指南。

材料与方法

对描述TAI诊断的文章进行文献检索。此外,总结了TAI的治疗和随访指南。

结果

尽管传统胸部X线检查特异性较低,但在文献中仍被列为初始诊断方法。主要地,由于计算机断层扫描(CT)具有高敏感性和特异性,应作为诊断和治疗分层的首选方法。所有指南均推荐胸主动脉腔内修复术(TEVAR)作为较高等级TAI(II-IV级)的一线治疗方法,并且在大多数情况下已取代了开放手术。

结论

在通过CT对TAI进行快速诊断和分类后,在大多数情况下,TEVAR已成为优于开放手术的首选治疗方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/31d6/8370906/9639f315fa32/113_2021_1044_Fig1_HTML.jpg

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