頁籤選單縮合
題名 | Traumatic Rupture of Thoracic Aorta=創傷性胸主動脈破裂 |
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作者 | 林佳勳; 呂明仁; 洪啟仁; | 書刊名 | Acta Cardiologica Sinica |
卷期 | 13:3 民86.07-09 |
頁次 | 頁145-151 |
分類號 | 416.14 |
關鍵詞 | 胸主動脈破裂; 主動脈攝影; 寬上縱膈腔; Aortic rupture; Aortography; Mediastinum widening; |
語文 | 英文(English) |
中文摘要 | 背景:胸主動脈破裂通常是因為胸部遭受鈍傷所造成。在今日,由於現代交通工具的普遍與發達,車禍的增加,也使得此病例的數目明顯的隨之增加。因為胸主動脈破裂的致死率極高,往往發生當時病人就會死亡,所以急診室中可以得見倖存的病例亦較少數,此外,這類病人多伴隨有數處的創傷,如頭部外傷、腹部鈍傷、骨折等,常成為醫護人員的注意所在,而容易忽略掉胸主動脈破裂的可能性,因此,只有對此診斷保持高度的警覺,才能及早發現。 方法與結果:從1994年11月至1996年6月,本院共有3例創傷性胸主動脈破裂,其致病機轉為車禍以及從高處落下,各合併有頭部外傷、腹部鈍傷及股骨骨折,三例在確定診斷後皆儘速接受手術治療,手術發現其破裂處皆在主動脈峽部,我們以人工血管置入接合來修補,術後三病人皆恢復良好。 結論:及早正確的診斷與適當的手術治療才能使病人預後良好。診斷上,胸部X光片中上縱膈腔的變寬,仍是最主要的徵象,而確定診斷則須根據主動脈攝影,主動脈攝影不但可以用來確定診斷,還可以看出破裂之處與範圍。任何的主動脈破裂都必須要手術治療,無論是急性破裂或是已形成慢性偽瘤手術方式以人工血管置入接合為主,而僅部份主動脈壁的破損則可考慮直接修補。 |
英文摘要 | Background. Aortic injury by non-penetrating trauma is relatively common for the popularity of motor vehicles traveling at present. Because this injury is usually highly fatal, early diagnosis and prompt treatment are important and decisive for a good prognosis. This article presents experience at this hospital in the management of traumatic rupture of thoracic aorta. Methods. From November 1994 to June 1996. three cases of traumatic aortic rupture were encountered here. Two male patients, age 17 and 24 respectively, were victims of motorcycle accidents, and a 35-year-old female patient fell from a great height. All three had associated injuries. Both male patients had left hemothorax with superior mediastinum widening in chest roentgenography (CXR) and positive aortography. Before the subsequent aortic surgery was performed, one had a period of Neurologic Intensive Care and the other had received exploratory laparotomy. Complete transection of aorta at the isthmus was found in both cases. The female patient had developed a large traumatic aortic pseudoaneurysm one month after injury. Almost complete transection of the aorta, at the isthmus with pseudoaneurysm formation, was noted during operation. Results. The surgical technique applied to all patients was graft interposition with Dacron conduit. In Case 1 and Case 2, the adjuvant procedure used to support the distal circulation was Gott shunt. And in Case 3, it was hypothermic circulatory arrest with retrograde cerebral perfusion for better brain, spinal cord and visceral organs protection. The results of these cases were good with no ischemic complications. Conclusion. All patients of high-speed deceleration accidents must be suspected to have aortic injury. Attention to radiological details is very important. Aortography is necessary not only to establish the diagnosis, but also to determine the location and extent of the lesions. The interposition of a prosthetic vascular graft to the aortic defect is the most commonly used technique for surgical repair. Distal circulation support with heparinized shunt or bypass are advantageous. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。