Orend K H, Kirchdorfer B, Sunder-Plassmann L
Department of Thoracic and Vascular Surgery, University of Ulm Germany.
Ann Ital Chir. 1996 Jan-Feb;67(1):21-3; discussion 23-5.
Timing and tactics in the repair of the traumatic ruptured thoracic aorta are matter of controversy ever since. The unmeasurable risk of a consecutive rupture favours a primary repair, concomitant injuries, however, a delayed repair. In single injuries of the thoracic aorta the clamp/repair procedure within 24 hours generates acceptable results with an overall mortality of 4 to 8% and a risk of ischemic myelopathy of 8 to 10%. Delayed repair reduces these figures not at all. Extracorporal circulation produces rather worse results in contrast to clamp/repair procedures. In cases of severe concomitant injuries, e.g. brain damage, hemorrhage and open fractures a delayed repair after cardiopulmonary reconstitution is required. In cases with posttraumatic pulmonary insufficiency the risk of surgical procedure itself is much higher than the risk of a second rupture of the traumatized thoracic aorta. We demonstrate our tactics in the repair of traumatic rupture of the descending aorta displaying clinical operated 1992/93.
自那以后，创伤性胸主动脉破裂修复的时机和策略一直存在争议。后续破裂的不可估量风险倾向于一期修复，然而，合并伤则倾向于延迟修复。在胸主动脉单一损伤中，24小时内的钳夹/修复手术可产生可接受的结果，总体死亡率为4%至8%，缺血性脊髓病风险为8%至10%。延迟修复丝毫不能降低这些数字。与钳夹/修复手术相比，体外循环产生的结果相当糟糕。在严重合并伤的情况下，如脑损伤、出血和开放性骨折，需要在心肺复苏后进行延迟修复。在创伤后肺功能不全的病例中，手术本身的风险远高于创伤性胸主动脉二次破裂的风险。我们展示了1992/93年临床手术的降主动脉创伤性破裂修复策略。
