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目的 总结单中心胸腹主动脉创伤的治疗方法,寻找适宜的治疗方案. 方法 回顾性分析2002年10月-2013年2月收治的主动脉创伤患者34例,其中男28例,女6例;平均年龄41岁(11 ～60岁).致伤原因:交通伤14例,高处坠落伤7例,刀刺伤3例,腹部挤压伤3例,误食鱼刺导致主动脉食管瘘3例,行介入治疗损伤主动脉引起主动脉夹层2例,室缺封堵器脱落划伤腹主动脉1例,脊柱手术过程中误伤主动脉1例.胸主动脉损伤23例,其中锐性损伤6例,钝性损伤17例;腹主动脉损伤11例,其中锐性损伤4例,钝性损伤7例.比较术前影像学表现、治疗方法和随访结果. 结果 根据致伤机制结合术前影像学表现制订个体化治疗方案.(1)锐性伤患者治疗结果:胸主动脉锐性伤非手术治疗2例,均死亡;腔内修复治疗4例,其中进展1例,治愈2例,死亡1例.腹主动脉锐性伤4例均开放手术探查治疗,其中治愈3例,致残1例.(2)钝性伤患者治疗结果:胸主动脉钝性伤非手术治疗治愈3例,死亡1例;腔内修复治愈11例,死亡1例;开放手术治愈1例.腹主动脉钝性伤非手术治疗6例;开放手术治疗1例. 结论 主动脉创伤治疗方法的选择需根据患者损伤情况、损伤部位、是否合并动脉破裂或破裂先兆等因素而定.腔内修复治疗胸腹主动脉创伤成功率高,效果满意.

Objective To review the case data and treatment methods in a single center so as to search for rational treatments for thoracoabdominal aortic trauma.Methods This retrospective analysis was performed for 34 cases (28 males and 6 females) sustaining thoracoabdominal aortic trauma treated from October 2002 to February 2013.The mean age was 41 years (range,11-60 years).Causes of injury included traffic crashes in 14 cases,high falls in 7,stab wound in 3,abdominal crash injury in 3,aorticoesophageal fistula caused by a fish bone in 3,interventional therapy-induced aortic dissection in 2,abdominal aortic injury caused by the dropped ventricular septal defect occluder in 1,and accidental aortic injury in spinal operation in 1.There were 23 cases of thoracic aortic trauma (6 sharp and 17 blunt) and 11 cases of abdominal aortic trauma (4 sharp and 7 blunt).Preoperative imaging findings,treatment methods and follow-up data were studied.Results Personal treatment was produced based on the mechanism of injury and imaging findings.Of sharp thoracic aortic trauma,2 cases were treated non-operatively but both died,and four cases had endovascular repair (one progressed,two cured,and one died).All the four cases of sharp abdominal aortic trauma had open surgery (three cured and one severely complicated).Of thoracic aortic trauma,four cases were treated non-operatively (three cured and one died),twelve cases had endovascular repair (11 cured and one died),and one case had open surgery and cured.Six cases of blunt abdominal aortic trauma were treated non-operatively and one had open surgery.Conclusions Treatment of aortic trauma should be based on injury condition,injury site,and occurrence of aortic rupture or impending of aortic rupture.Endovascular repair has a high success rate and good clinical outcome in treatment of thoracoabdominal aortic trauma.