CT影像对胸主动脉钝性伤的病灶形态分类的意义探讨

发表时间：2014-06-16 浏览次数：1259次

引用：

康慧，杨建，张仁宇等.CT影像对胸主动脉钝性伤的病灶形态分类的意义探讨[J].中华创伤杂志.2013, 29(3):207-210.

关键词：

胸主动脉钝性创伤,最小主动脉损伤

作者：

康慧，杨建，张仁宇，谭今，杨帆，张尔永

作者单位：

四川大学华西医院胸心血管外科,成都,610041

出版年份：

2013

期刊页数：

207-210

收录者：

知网,万方

摘要：

目的探讨对胸主动脉钝性创伤(blunt traumatic thoracic aortic injury,BTTAI)病灶的影像学分型,考量其分型对手术选择的参考价值. 方法 BTTAI共12例,按CT显示主动脉损害局部病灶的轮廓分为三型:A型,主动脉血管轮廓形态正常而管腔内有内膜片游离；B型,轮廓异常且造影剂渗漏到主动脉管腔外但局限于纵隔内；C型,轮廓异常且造影剂渗漏到胸腔.结合全身ISS、局部损害位置、手术救治方式、患者结局等信息,对分型价值进行探讨. 结果 12例均为全身多发伤合并BTTAI,其主动脉病灶影像均可被上述分型所概括.BTTAI的病灶影像:A型3例,B型7例,C型2例,验证假性动脉瘤为最常见BTTAI.各型BTTAI的ISS、低血压率、救治方式或死亡率差异均无统计学意义. 结论 BTTAI多见于多发伤,总体伤情的评估并不限于主动脉局部病灶类型.本病灶分型反映血管壁损害程度,结合病灶位置和毗邻关系(特别是锚碇区的长度),对手术决策具有明确的参考价值. Objective To discuss imaging classification of blunt traumatic thoracic aortic injury (BTTAI) and weigh guideline value of its imaging classification to surgical options.Methods BTTAI in 12 patients were divided into three types in accordance with outline of aortic injury revealed by CT imaging,i.e.,type A of normal outline of aortic blood vessel but free endothelium in aortic cavity,type B of abnormal aortic outline and contrast extravasation to aortic lumen exterior but only confining to mediastina,and type C of abnormal aortic outline and contrast leakage to thoracic cavity.Significance of BTTAI morphological classification was analyzed according to data,such as systemic injury severity score (ISS),local injury sites,surgical approaches and patients' outcome.Results Multiple injuries combined with BTTAI were observed in all patients whose aortic lesion image could be all generalized by above-mentioned classification.BTTAI image showed type A in three patients,type B in seven and type C in two.Pseudoaneurysm was confirmed as the foremost common BTTAI.There were no significant differences in ISS,hypotension morbidity,treatment methods or mortality between each type of BTTAI.Conclusions BTTAI occurs mostly in multiple injuries and thus overall injury severity assessment is not only depended on aortic lesion classification.BTTAI classification in this study reflects injury severity of vessel wall,takes account to location of lesion and adjacent relations (especially length of landing zone) and hence has accurate referential value for surgical decisions.

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