Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Surgical Treatment of Traumatic Rupture of Thoracic Aorta

외상성 흉부대동맥 파열 수술

  • Hahm, Shee-Young (Dept. of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choo, Suk-Jung (Dept. of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Song, Hyun (Dept. of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Jae-Won (Dept. of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Song, Meong-Gun (Dept. of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • 함시영 (울산대학교 서울아산병원 흉부외과) ;
  • 주석중 (울산대학교 서울아산병원 흉부외과) ;
  • 송현 (울산대학교 서울아산병원 흉부외과) ;
  • 이재원 (울산대학교 서울아산병원 흉부외과) ;
  • 송명근 (울산대학교 서울아산병원 흉부외과)
  • Published : 2004.09.01
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Abstract

Although traumatic thoracic aortic rupture is potentially a fatal condition requiring surgical attention, the presence of concomitant injury involving other parts of the body may greatly increase the risk of cardio-pulmonary bypass. We report our experience of treating associated injuries prior to the thoracic aortic rupture in these patients. Material and Method: From 1997 to 2003, the medical records of 24 traumatic aortic rupture patients were retrospectively reviewed and checked for the presence of associated injury, surgical method, postoperative course, and complications. Surgical technique comprised thoracotomy with proximal anastomosis under deep hypothermic circulatory arrest followed by side arm perfusion to reestablish cerebral circulation. CSF drainage was performed to prevent lower extremity paraplegia. Result： Major concomitant injuries (n=83) were noted in all of the reviewed patients, Of these, there were 49 thoracic injuries, 18 musculoskeletal injuries, and 13 abdominal injuries, Operations for associated injuries (n=16) were performed in 12 patients on mean 7.6$\pm$12.6 days following the injury. The diagnosis of aortic rupture at the time of injury was detected in only 18 patients. Delayed surgery of the thoracic aorta was performed on average 695$\pm$1350 days after injury and there were no deaths or progression of rupture in any of these patients during the observation period. There were no operative deaths and no major postoperative complications. Conclusion: Treating concomitant major injuries prior to the aortic injury in traumatic aortic rupture may reduce surgical mortality and morbidity.

외상성 흉부대동맥 파열은 수술적 치료가 요구되는 치명적 손상이며 이외에 다른 부위에 복합손상이 동반되면 심폐 바이패스에 의한 위험도를 크게 증가시킬 수 있다. 여기서 저자들은 심한 동반손상을 먼저 치료한 후 대동맥수술을 하고 그 결과를 관찰하였다. 대상 및 방법: 1997년부터 2003년까지 외상성 흉부 대동맥질환으로 수술을 받은 24명의 환자를 대상으로 의무기록을 후향적으로 검토하여, 동반손상 여부, 수술방법, 수술 후 경과, 합병증 등을 분석하고 국내외 문헌들과 비교하였다. 수술은 초저온 심정지법하에서 심폐 바이패스를 이용한 개흉술로 하였는데 근위부 연결 후 곁가지를 통해 뇌관류를 시행하였고 요추 카테터를 통한 뇌척수액 배액으로 하반신 마비를 예방하였다. 결과： 대상환자 전원에서 83예의 동반손상이 발생하였는데, 흉부손상이 49예, 근골격계 손상 18예, 복부 손상 13예였고, 수상 후 12명의 환자에서 7.6$\pm$12.6일에 16예의 동반손상에 대한 수술이 행해졌다. 수상당시 18예에서만 대동맥 손상이 진단되었다. 중환자실에서 혈압을 약물투여로 조절하면서 안정시키고 수상 후 693 $\pm$ 1350일에 지연수술을 시행하였는데, 관찰기간 중 사망이나 대동맥 파열의 진행은 없었다. 수술 사망은 없었으며, 술 후 큰 합병증은 없었다. 결론： 외상성 흉부대동맥 파열에 있어서 다른 부위 손상이 동반되면 심한 동반손상을 먼저 치료한 후 수술하는 것이 수술 사망률이나 이병률 면에서 좋은 결과를 가져온다.

Keywords

References

  1. Ann Thorac Surg v.74 no.5 Delayed operative intervention in the management of traumatic descending thoracic aortic rupture Kwon CC;Gill IS;Fallen WF(et al.)
  2. Eur J Cardiothorac Surg v.21 Surgical treatment of acute traumatic rupture of the thoracic aorta a timing reappraisal? Langanay T;Verhoye JP;Corbineau H(et al.)
  3. J Thorac Cardiovasc Surg v.100 Rupture of thoracic aorta caused by blunt trauma. A fifteen-year experience. Cowley ES;Turney SZ;Hankins JR(et al.)
  4. Arch Surgery v.135 no.8 Repair of traumatic aortic rupture. A 25-year experience Razzouk AJ;Gundry SR; Wang N(et al.)
  5. N Eng J Med v.332 Transesophageal echocardiography in the diagnosis of traumatic rupture of the aorta Smith MD;Cassidy JM;Souther S(et al.)
  6. Arch Surg v.119 no.8 Traumatic pseudoaneurysms of the thoracic aorta: anatomic and radiologic correlations Gundry SR;Burney RE;Mackenzie JR(et al.)
  7. Ann Thorac Surg v.66 Rupture of the ascending aorta caused by blunt trauma Symbas PJ;Horsley WS;Symbas PN
  8. Eur J Cardiothorac Surg v.13 Evolution of posttraumatic aortic aneurysm in the subacute phase: magnetic resonance imaging follow-up as a support of the surgical timing Fattori R;Celletti F;Descovich B(et al.)
  9. Ann Thorac Surg v.40 Clamp/repair: a safe technique for treatment of blunt injury to the descending thoracic aorta Mattox KL;Holzman M;Pickard LR(et al.)
  10. Ann Thorac Surg v.58 Traumatic aortic rupture: twenty-year meta-analysis of mortality and risk of mortality and fisk of paraplegia Von Oppel UO;Dunne TT;De Groot MK;Zilla P
  11. J Trauma v.42 Alternative surgical approach for posttraumatic thoracic aortic pseudoaneurysm Mull DH;Jessen ME
  12. Surgery of the chest (6th ed.) Trauma to the chest Wisner DH;Sabiston Jr DC(ed.); Spencer FC(ed.)
  13. Kirklin/Barratt-Boyes Cardiac Sutgery (3rd ed.) Acute traumatic aortic transection Kouchoukos NT;Blackstone EH;Doty DB(et al.)