切换至 "中华医学电子期刊资源库"

中华损伤与修复杂志(电子版) ›› 2023, Vol. 18 ›› Issue (05) : 438 -441. doi: 10.3877/cma.j.issn.1673-9450.2023.05.013

综述

钝性主动脉损伤诊治的研究进展
张熙浩, 陈作观, 李拥军()   
  1. 100730 北京医院血管外科 国家老年医学中心 中国医学科学院老年医学研究院;100730 北京大学第五临床医学院
    100730 北京医院血管外科 国家老年医学中心 中国医学科学院老年医学研究院
  • 收稿日期:2023-07-29 出版日期:2023-10-01
  • 通信作者: 李拥军
  • 基金资助:
    中国医学科学院医学与健康科技创新工程重大协同创新项目(CIFMS 2021-I2M-1-050)

Recent advances in diagnosis and treatment of blunt aortic injury

Xihao Zhang, Zuoguan Chen, Yongjun Li()   

  1. Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China; Peking University Fifth School of Clinical Medicine, Beijing 100730, China
    Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
  • Received:2023-07-29 Published:2023-10-01
  • Corresponding author: Yongjun Li
引用本文:

张熙浩, 陈作观, 李拥军. 钝性主动脉损伤诊治的研究进展[J]. 中华损伤与修复杂志(电子版), 2023, 18(05): 438-441.

Xihao Zhang, Zuoguan Chen, Yongjun Li. Recent advances in diagnosis and treatment of blunt aortic injury[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2023, 18(05): 438-441.

钝性主动脉损伤是一种具有潜在致命性的严重血管创伤,因其临床表现无特异性、常合并其他创伤,在很多情况下不能得到及时诊断和治疗。计算机断层扫描血管造影(CTA)目前已成为诊断钝性主动脉损伤的首选检查方式。基于CTA的动脉损伤分级是患者围手术期死亡的决定性因素,也是选择不同治疗方案的重要依据。根据损伤分级的不同,患者可行保守治疗或手术治疗。在解剖和临床条件允许情况下,目前主流术式是血管内修复术。相比于开放手术,血管内修复术对于减少围手术期并发症及死亡具有明显优势。本文就钝性主动脉损伤的诊断、分级和治疗研究进展作一综述,为钝性主动脉损伤的临床诊治提供参考。

Blunt aortic injury is a potentially fatal vascular trauma. However, due to its non-specific clinical manifestations and common combination with other traumas, it is difficult to be diagnosed and treated in time in many cases. Computed tomography angiography (CTA) has become the first choice for the diagnosis of blunt aortic injury. The grade of arterial injury based on CTA is an important determinant for perioperative mortality, as well as the indication of treatment. According to the severity of arterial injury, patients may receive conservative or surgical treatment. As long as the anatomical and clinical conditions permit, the mainstream operation is endovascular repair. Endovascular repair has a significant advantage over open surgery in reducing perioperative complications and death. This article reviewed the research progress of diagnosis, classification and treatment of blunt aortic injury, aiming to provide reference for clinical diagnosis and treatment of blunt aortic injury.

[1]
Cowley RA, Turney SZ, Hankins JR, et al. Rupture of thoracic aorta caused by blunt trauma. A fifteen-year experience[J]. J Thorac Cardiovasc Surg, 1990, 100(5): 652-660.
[2]
Sevitt S. The mechanisms of traumatic rupture of the thoracic aorta[J]. Br J Surg, 1977, 64(3): 166-173.
[3]
Teixeira PG, Inaba K, Barmparas G, et al. Blunt thoracic aortic injuries: an autopsy study[J]. J Trauma, 2011, 70(1): 197-202.
[4]
Dinh K, Limmer A, Ngai C, et al. Blunt thoracic aorta injuries, an Australian single centre's perspective[J]. ANZ J Surg, 2021, 91(4): 662-667.
[5]
De Mestral C, Dueck A, Sharma SS, et al. Evolution of the incidence, management, and mortality of blunt thoracic aortic injury: a population-based analysis[J]. J Am Coll Surg, 2013, 216(6): 1110-1115.
[6]
Yu L, Baumann BM, Raja AS, et al. Blunt traumatic aortic injury in the pan-scan era[J]. Acad Emerg Med, 2020, 27(4): 291-296.
[7]
Demetriades D, Velmahos GC, Scalea TM, et al. Diagnosis and treatment of blunt thoracic aortic injuries: changing perspectives[J]. J Trauma, 2008, 64(6): 1415-1418.
[8]
Mirvis SE, Shanmuganathan K, Buell J, et al. Use of spiral computed tomography for the assessment of blunt trauma patients with potential aortic injury[J]. J Trauma, 1998, 45(5): 922-930.
[9]
杜倩妮,李宇,张楠,等. 基于主动脉CT血管成像的钝性主动脉损伤分级在临床决策中的指导价值[J]. 心肺血管病杂志2020, 39(9): 1106-1110.
[10]
Fox N, Schwartz D, Salazar JH, et al. Evaluation and management of blunt traumatic aortic injury: a practice management guideline from the Eastern Association for the Surgery of Trauma[J]. J Trauma Nurs, 2015, 22(2): 99-110.
[11]
Mouawad NJ, Paulisin J, Hofmeister S, et al. Blunt thoracic aortic injury-concepts and management[J]. J Cardiothorac Surg, 2020, 15(1): 62.
[12]
Bae M, Jeon CH. Optimal sizing of aortic stent graft for blunt thoracic aortic injury considering hypotension-related decrease in aortic diameter[J]. J Endovasc Ther, 2022: 15266028221134894.
[13]
Osman A, Fong CP, Wahab SFA, et al. Transesophageal echocardiography at the golden hour: identification of blunt traumatic aortic injuries in the emergency department[J]. J Emerg Med, 2020, 59(3): 418-423.
[14]
Mazzaccaro D, Righini P, Fancoli F, et al. Blunt thoracic aortic injury[J]. J Clin Med, 2023, 12(8): 2903.
[15]
Crapps JL, Efird J, Dubose JJ, et al. Is chest X-ray a reliable screening tool for blunt thoracic aortic injury? Results from the American association for the surgery of trauma/aortic trauma foundation prospective blunt thoracic aortic injury registry[J]. J Am Coll Surg, 2023, 236(5): 1031-1036.
[16]
Parmley LF, Mattingly TW, Manion WC, et al. Nonpenetrating traumatic injury of the aorta[J]. Circulation, 1958, 17(6): 1086-1101.
[17]
Azizzadeh A, Keyhani K, Miller CC 3rd, et al. Blunt traumatic aortic injury: initial experience with endovascular repair[J]. J Vasc Surg, 2009, 49(6): 1403-1408.
[18]
Lee WA, Matsumura JS, Mitchell RS, et al. Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the Society for Vascular Surgery[J]. J Vasc Surg, 2011, 53(1): 187-192.
[19]
Lamarche Y, Berger FH, Nicolaou S, et al. Vancouver simplified grading system with computed tomographic angiography for blunt aortic injury[J]. J Thorac Cardiovasc Surg, 2012, 144(2): 347-354.
[20]
Dubose JJ, Charlton-Ouw K, Starnes B, et al. Do patients with minimal blunt thoracic aortic injury require thoracic endovascular repair?[J]. J Trauma Acute Care Surg, 2021, 90(2): 384-387.
[21]
Kapoor H, Lee JT, Orr NT, et al. Minimal aortic injury: mechanisms, imaging manifestations, natural history, and management[J]. Radiographics, 2020, 40(7): 1834-1847.
[22]
Trust MD, Teixeira PGR. Blunt trauma of the aorta, current guidelines[J]. Cardiol Clin, 2017, 35(3): 441-451.
[23]
Dahal R, Acharya Y, Tyroch AH, et al. Blunt thoracic aortic injury and contemporary management strategy[J]. Angiology, 2022, 73(6): 497-507.
[24]
刘延华,何发明,梁志强,等. 钝性主动脉损伤的治疗[J]. 中国胸心血管外科临床杂志2013, 20(5): 615-616.
[25]
朴雪瑞,严志强,陈英. 基于CT图像的轻度胸主动脉钝性创伤的意义探讨[J]. 医学影像学杂志2017, 27(11): 2090-2093.
[26]
Spencer SM, Safcsak K, Smith CP, et al. Nonoperative management rather than endovascular repair may be safe for grade II blunt traumatic aortic injuries: an 11-year retrospective analysis[J]. J Trauma Acute Care Surg, 2018, 84(1): 133-138.
[27]
Gaffey AC, Zhang J, Saka E, et al. Natural history of nonoperative management of grade II blunt thoracic aortic injury[J]. Ann Vasc Surg, 2020, 65: 124-129.
[28]
Azizzadeh A, Charlton-Ouw KM, Chen Z, et al. An outcome analysis of endovascular versus open repair of blunt traumatic aortic injuries[J]. J Vasc Surg, 2013, 57(1): 108-114.
[29]
Cheng YT, Cheng CT, Wang SY, et al. Long-term outcomes of endovascular and open repair for traumatic thoracic aortic injury[J]. JAMA Netw Open, 2019, 2(2): e187861.
[30]
Xenos ES, Abedi NN, Davenport DL, et al. Meta-analysis of endovascular vs open repair for traumatic descending thoracic aortic rupture[J]. J Vasc Surg, 2008, 48(5): 1343-1351.
[31]
曾彦彰,袁平,何强,等. 钝性胸主动脉损伤腔内治疗的临床结果分析[J]. 中国血管外科杂志(电子版), 2022, 14(3): 242-244.
[32]
李坤,张克伟,崔明哲,等. 腔内修复术治疗急性钝性胸主动脉损伤的结果分析[J]. 临床放射学杂志2021, 40(4): 800-805.
[33]
孙磊,秦涛,吴海卫,等. 腔内修复术治疗钝性主动脉损伤临床分析[J]. 创伤外科杂志2019, 21(12): 885-888.
[34]
张婉,符伟国,陈斌,等. 腔内治疗钝性主动脉损伤的中期随访及主动脉重构[J]. 中国胸心血管外科临床杂志2018, 25(4): 278-283.
[35]
Harky A, Bleetman D, Chan JSK, et al. A systematic review and meta-analysis of endovascular versus open surgical repair for the traumatic ruptured thoracic aorta[J]. J Vasc Surg, 2020, 71(1): 270-282.
[36]
Maruhashi T, Maruki H, Mishima T, et al. Hybrid surgery for blunt aortic injury with rupture: a case report[J]. J Cardiothorac Surg, 2022, 17(1): 301.
[37]
任为,李追. 钝性主动脉损伤的腔内治疗进展[J]. 创伤外科杂志2019, 21(12): 881-884.
[38]
何庚戌,刘俊堂,濮仁富,等. 钝性外伤性主动脉损伤的诊断及治疗策略的选择[J]. 心脏杂志2018, 30(6): 708-712.
[39]
Romijn AC, Rastogi V, Proaño-Zamudio JA, et al. Early versus delayed thoracic endovascular aortic repair for blunt thoracic aortic injury: a propensity-score matched analysis[J]. Ann Surg, 2023, 278(4): e848-e854.
[40]
Mandigers TJ, Bissacco D, Domanin M, et al. Cardiac and aortic modifications after endovascular repair for blunt thoracic aortic injury: a systematic review[J]. Eur J Vasc Endovasc Surg, 2022, 64(2-3): 176-187.
[41]
Gennai S, Leone N, Mezzetto L, et al. Systematic review and meta-analysis of long-term reintervention following thoracic endovascular repair for blunt traumatic aortic injury[J]. J Vasc Surg, 2023, 78(2): 540-547.
[1] 任书堂, 刘晓程, 张亚东, 孙佳英, 陈萍, 周建华, 龙进, 黄云洲. 左心室辅助装置支持下单纯收缩期主动脉瓣反流的超声心动图特征[J]. 中华医学超声杂志(电子版), 2023, 20(10): 1023-1028.
[2] 吴群, 张鑫, 李培, 王芳韵, 郑淋, 卫海燕, 马宁. 孤立型主动脉缩窄的超声心动图诊断及术后随访研究[J]. 中华医学超声杂志(电子版), 2023, 20(06): 642-646.
[3] 应康, 杨璨莹, 刘凤珍, 陈丽丽, 刘燕娜. 左心室心肌应变对无症状重度主动脉瓣狭窄患者的预后评估价值[J]. 中华医学超声杂志(电子版), 2023, 20(06): 581-587.
[4] 李嵘娟, 宋砾, 王月丽, 崇梅, 牛宝荣, 李菁, 陈倬, 谷孝艳, 张涵, 张烨, 何怡华. 大动脉炎与白塞病所致主动脉瓣反流的临床及超声心动图特征分析[J]. 中华医学超声杂志(电子版), 2023, 20(02): 213-218.
[5] 陈世远, 余朝文, 高涌, 王孝高, 张克霏. 3D打印、体外开窗、CTA与DSA融合在胸腹主动脉瘤腔内治疗中的应用[J]. 中华普通外科学文献(电子版), 2023, 17(02): 128-128.
[6] 徐哲, 罗杰, 吴强, 李忠, 王晓伟, 郑硕, 郝晓东, 王照. 腹主动脉钙化患者肾结石成分特点及危险因素分析[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 481-485.
[7] 王细文, 刘恒炜, 黄桔园, 易跃雄, 张蔚. 单孔腹腔镜UGF两翼法腹主动脉旁淋巴结切除术[J]. 中华腔镜外科杂志(电子版), 2023, 16(04): 246-248.
[8] 周洋, 曹学, 赵飞, 郑波, 查惠娟, 蒋娜, 罗俊, 熊伟. 血清miR-22、HSPB1水平与急性Stanford A型主动脉夹层患者预后的关系[J]. 中华临床医师杂志(电子版), 2023, 17(03): 243-248.
[9] 钱建伟, 周春高, 田伟, 祖庆泉, 严海涛, 施海彬, 刘圣. 腔内修复急性Stanford B型主动脉夹层后支架远端主动脉重塑的因素分析[J]. 中华介入放射学电子杂志, 2023, 11(03): 230-235.
[10] 杨伟洪, 向先俊, 郭宗锦, 王亮, 周汝明, 魏民新, 王赞鑫. 主动脉夹层累及腹腔分支二期腔内治疗的中期研究[J]. 中华介入放射学电子杂志, 2023, 11(03): 236-240.
[11] 邹艳丽, 栾文杰, 王淑娟, 刘亚琴, 初桂芝, 李松洋, 王好玲, 张锦婷, 姜鑫, 栾泽东. 早孕期胎儿右位主动脉弓的产前超声诊断学特征[J]. 中华诊断学电子杂志, 2023, 11(04): 227-232.
[12] 王昕禹, 赵国政, 徐娟, 刘淑萍, 李利. 腹主动脉瘤腔内修复术后内漏与左肾周血肿的超声造影诊断特征[J]. 中华诊断学电子杂志, 2023, 11(04): 239-243.
[13] 潘文志, 龙愉良, 周达新, 葛均波. 单纯主动脉瓣反流经导管主动脉瓣置换的解剖分析及操作技巧[J]. 中华心脏与心律电子杂志, 2023, 11(03): 141-146.
[14] 陈丹丹, 潘文志, 陈莎莎, 张源, 张晓春, 李明飞, 周达新, 葛均波. 结构性心脏病年度报告2022[J]. 中华心脏与心律电子杂志, 2023, 11(03): 129-140.
[15] 李安, 张秀萍, 白波, 赵阳, 薛国芳, 李东芳. 主动脉夹层术后并发神经系统并发症二例及文献复习[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 373-378.
阅读次数
全文


摘要