Svensson L G, Antunes M D, Kinsley R H
S Afr Med J. 1985 May 25;67(21):853-7.
The major controversy in the surgical repair of acute traumatic rupture of the aorta (TRA) is about the need for distal perfusion and whether or not the benefits of clamping justify the risks involved. To resolve this issue, our experience and 596 cases of acute TRA reported in the English-language literature were reviewed. The operative mortality and incidence of paraplegia among patients who underwent total or partial cardiopulmonary bypass, local temporary aorto-aortic shunting or simple cross-clamping were analysed statistically. The respective mortality rates after the above three procedures were 16,7%, 11,4% and 5,8%, and mortality was significantly increased when distal perfusion techniques were used (P less than 0,01). The incidences of paraplegia among patients who underwent partial left heart bypass, temporary shunting and simple aortic cross-clamping were 2,2%, 2,3% and 5,8% respectively (the differences did not reach statistical significance). Methods of management are discussed. Simple aortic cross-clamping remains the method of choice in uncomplicated cases of acute TRA.
急性创伤性主动脉破裂（TRA）手术修复中的主要争议在于是否需要进行远端灌注，以及阻断主动脉的益处是否能证明其所涉及的风险是合理的。为了解决这个问题，我们回顾了自己的经验以及英文文献中报道的596例急性TRA病例。对接受全心肺转流、部分心肺转流、局部临时主动脉 - 主动脉分流或单纯阻断主动脉的患者的手术死亡率和截瘫发生率进行了统计学分析。上述三种手术方法后的死亡率分别为16.7%、11.4%和5.8%，并且当使用远端灌注技术时死亡率显著增加（P小于0.01）。接受部分左心转流、临时分流和单纯主动脉阻断的患者截瘫发生率分别为2.2%、2.3%和5.8%（差异未达到统计学意义）。讨论了治疗方法。在急性TRA的非复杂病例中，单纯主动脉阻断仍然是首选方法。
