Blunt Traumatic Rupture of the Aorta

胸部鈍傷合併主動脈破裂

趙盛豐(Shen-Feng Chao) ； 張比嵩(Bee-Song Chang)

《慈濟醫學雜誌》 16卷3期 (2004/06) Pp. 137-142

https://doi.org/10.6440/TZUCMJ.200406.0137

摘要

目的：外傷性主動脈破裂是胸部鈍傷潛在的致命性併發症。本文報告東部地區外傷性主動脈破裂手術治療的結果。病人與方法：民國85年8月到民國89年10月共有6位外傷性主動脈破裂的患者在佛教慈濟綜合醫院接受手術治療。5位患者胸部X光片發現縱膈腔變寬。6位病患分別接受注射顯影劑的胸部電腦斷層攝影，或食道超音波檢查，或核磁共振影像檢查，或主動脈攝影。結果：所有患者的主動脈破裂皆位於主動脈峽部並且皆由左側開胸進行人工血管植入修補手術。一位患者使用Gott氏分流管，其餘5位患者則採用股動脈股靜脈部分體外循環。一位合併肝臟撕裂傷與腹腔內出血的患者選擇性在受傷72小時後才接受主動脈修補，成功的避免了剖腹修補肝臟的手術。5位患者術後完全恢復，1例罕見的外傷性主動脈剝離患者手術後死於急性腎衰竭及高血鉀症。結論：外傷性主動脈破裂應該儘速接受治療。注射顯影劑的胸部電腦斷層是急診室第一優先選擇的檢查工具，核磁共振影像檢查可以用在病情較穩定的患者，主動脈攝影應避免採用。少數患者的主動脈破裂修補可以延後來避免不必要的剖腹手術。使用股動脈股靜脈部分體外循環成功的避免下半身不遂。

關鍵字

胸部鈍傷 ； 外傷性主動脈破裂 ； 主動脈峽部破裂

並列摘要

Objective: Aortic rupture is a potentially fatal complication in trauma. We report our surgical result in the treatment of traumatic aortic rupture in eastern Taiwan. Patients and Methods: From August 1996 to October 2000, six patients with traumatic aortic rupture had surgery at Tzu Chi General Hospital. Five had a widened mediastinum on chest X-ray examination. They were diagnosed using chest contrast-enhanced computed tomography (CT), transesophageal echography (TEE), magnetic resonance imaging (MRI), or aortogram. Results: All aortic ruptures were located at the aortic isthmus and were grafted via a left thoracotomy. A Gott's shunt was used in one patient and five patients received femorofemoral pump assistance. One patient with a liver laceration and internal bleeding underwent elective surgery 72 hours after injury. Laparotomy was successfully avoided. Five patients completely recovered after surgery. One patient with a rare case of traumatic aortic dissection died of acute renal failure with hyperkalemia after aorta repair. Conclusion: Traumatic aortic rupture should be treated as soon as possible. Computed tomography is the first choice in the emergency room. MRI can be used in relative stable patients. Aortography can be avoided. In selected case, aortic repair can be delayed to avoid laparotomy. Venous arterial femorofemoral pump assistance prevents paraplegia.

並列關鍵字

blunt chest trauma ； traumatic aorta rupture ； aortic isthmus rupture