摘要目的:探讨创伤性主动脉损伤的治疗方法和近中期效果。方法:回顾性分析2010年1月至2018年12月东部战区总医院心胸外科收治的30例创伤性主动脉损伤患者的临床资料。男性20例，女性10例，年龄（46.4±15.2）岁（范围：17~76岁）。所有患者经主动脉CT血管造影确诊为创伤性主动脉损伤。1例患者未见明确内膜损伤，诊断为广泛型壁间血肿，余29例有明确主动脉内膜损伤，原发内膜破口均位于降主动脉峡部，2例为溃疡样改变合并壁间血肿，27例为主动脉夹层，其中局限型主动脉夹层23例、广泛型主动脉夹层4例。根据患者具体病情行腔内修复、人工血管置换或保守治疗。出院后行门诊和电话随访。对患者在院期间治疗的临床资料和随访情况进行回顾性统计分析。结果:1例广泛型壁间血肿患者行保守治疗，29例主动脉内膜损伤患者行外科干预。其中15例于入院当天或次日行急诊手术，14例行择期手术；27例行主动脉腔内修复术，2例行开放胸主动脉人工血管置换术；9例先期或后期行其他部位手术。所有患者治愈出院，无在院死亡，住院时间（13.2±5.4）d（范围：7~30 d）。2例气管切开，余无严重并发症。至2019年6月最后一次随访，4例患者失访，余26例患者随访时间（50.6±34.1）个月（范围：6~112个月），均存活，无新发主动脉相关事件。结论:绝大多数创伤性主动脉夹层为Stanford B型夹层，急诊腔内修复可获得良好的近中期效果，部分患者采用开放性人工血管置换术有望获得良好的远期效果。

abstractsObjective:To examine the clinical treatment methods and short- and mid-term results of traumatic aortic injury (TAI).Methods:The clinical data of 30 patients suffering from TAI who were admitted to Department of Cardiothoracic Surgery, General Hospital of Eastern Theater Command from January 2010 to December 2018 were summarized and analyzed retrospectively. All patients were diagnosed as TAI by aortic CT angiography. There were 20 males and 10 females, aging (46.4±15.2) years (range: 17 to 76 years). One patient was diagnosed as extensive intramural hematoma (IMH). The other 29 cases had aortic intimal injury, and the primary intimal tear of all these patients was located in the isthmus of descending aorta. There were 2 cases of ulcer-like changes combined with IMH, and 27 cases of traumatic aortic dissection (TAD) including 23 cases of localized TAD and 4 cases of extensive TAD. Endovascular repair, artificial vascular replacement or conservative treatment were performed according to the patient′s specific condition. The patients were followed up in outpatient or by telephone. The clinical data of all the patients of the in-hospital treatment and during follow-up period was analyzed retrospectively.Results:One patient with IMH was treated conservatively. Surgical intervention was performed in 29 cases with intimal injury, of which 14 cases underwent emergency surgery on the day of admission or the next day, and 15 cases underwent elective surgery. Twenty-seven cases underwent thoracic endovascular aortic repair (TEVAR), and 2 cases underwent artificial vascular replacement. Nine cases suffered combined operations in early or late stage. All patients were cured and discharged with in-hospital stay of (13.2±5.4) days (range: 7 to 30 days). There was no in-hospital death. Two patients underwent tracheotomy, and the rest had no serious complications. Up to the last follow-up in June 2019, 4 patients were lost to follow-up, and the remaining 26 patients were followed up for (50.6±34.1) months (range: 6 to 112 months) and survived healthily without new aortic events.Conclusions:Most of TAD cases are ascribed to Stanford type B aortic dissection, and a satisfactory short-term and mid-term result can be achieved by emergency TEVAR in most patients. Some patients can achieve good long-term results by open surgery with artificial vascular replacement.