체간부 장기 손상을 동반한 외상성 체간부 동맥 손상 환자의 치료 방침 (Therapeutic Plan for Traumatic Truncal Arterial Injury Associated with Truncal Organ Injury)

서지정보

· 발행기관 : 대한외상학회
· 수록지 정보 : 대한외상학회지 / 22권 / 1호 / 77 ~ 86페이지
· 저자명 : 조충현, 정용식, 김욱환, 조영신, 안정환, 민영기, 정윤석, 김성희, 이국종

초록

Purpose: The appropriate management of traumatic truncal arterial injury is often difficult to determine, particularly
if the injury is associated with severe additional truncal lesions. The timing of repair is controversial
when patients arrive alive at the hospital. Also, there is an argument about surgery versus stent-graft repair.
This study’s objective was to evaluate the appropriate method and the timing for treatment in cases of truncal
abdominal injury associated with other abdominal lesions.
Methods: The medical records at Ajou University Medical Center were reviewed for an 8-year period from
January 1, 2001, to December 31, 2008. Twelve consecutive patients, who were diagnosed as having had a
traumatic truncal arterial injury, were enrolled in our study. Patients who were dead before arriving at the hospital
or were not associated with abdominal organ injury, were excluded. All patients involved were managed
by using the ATLS (Advanced Trauma Life Support) guideline. Data on injury site, the timing and treatment
method of repair, the overall complications, and the survival rate were collected and analyzed.
Results: Every case showed a severe injury of more than 15 point on the ISS (injury severity score) scale. The
male-to-female ratio was 9:3, and patients were 41 years old on the average. Sites of associated organ injury
were the lung, spleen, bowel, liver, pelvic bone, kidney, heart, vertebra, pancreas, and diaphragm ordered from
high frequency to lower frequency. There were 11 cases of surgery, and one case of conservative treatment. Two
of the patients died after surgery for truncal organ injury: one from excessive bleeding after surgery and the other
from multiple organ failure. Arterial injuries were diagnosed by using computed tomography in every case and 9
patients were treated by using an angiographic stent-graft repair. There were 3 patients whose vessels were normal
on admission. Several weeks later, they were diagnosed as having a truncal arterial injury.
Conclusion: In stable rupture of the truncal artery, initial conservative management is safe and allows management
of the major associated lesions. Stent grafting of the truncal artery is a valuable therapeutic alternative
to surgical repair, especially in patients considered to be a high risk for a conventional thoracotomy.

영어초록

Purpose: The appropriate management of traumatic truncal arterial injury is often difficult to determine, particularly
if the injury is associated with severe additional truncal lesions. The timing of repair is controversial
when patients arrive alive at the hospital. Also, there is an argument about surgery versus stent-graft repair.
This study’s objective was to evaluate the appropriate method and the timing for treatment in cases of truncal
abdominal injury associated with other abdominal lesions.
Methods: The medical records at Ajou University Medical Center were reviewed for an 8-year period from
January 1, 2001, to December 31, 2008. Twelve consecutive patients, who were diagnosed as having had a
traumatic truncal arterial injury, were enrolled in our study. Patients who were dead before arriving at the hospital
or were not associated with abdominal organ injury, were excluded. All patients involved were managed
by using the ATLS (Advanced Trauma Life Support) guideline. Data on injury site, the timing and treatment
method of repair, the overall complications, and the survival rate were collected and analyzed.
Results: Every case showed a severe injury of more than 15 point on the ISS (injury severity score) scale. The
male-to-female ratio was 9:3, and patients were 41 years old on the average. Sites of associated organ injury
were the lung, spleen, bowel, liver, pelvic bone, kidney, heart, vertebra, pancreas, and diaphragm ordered from
high frequency to lower frequency. There were 11 cases of surgery, and one case of conservative treatment. Two
of the patients died after surgery for truncal organ injury: one from excessive bleeding after surgery and the other
from multiple organ failure. Arterial injuries were diagnosed by using computed tomography in every case and 9
patients were treated by using an angiographic stent-graft repair. There were 3 patients whose vessels were normal
on admission. Several weeks later, they were diagnosed as having a truncal arterial injury.
Conclusion: In stable rupture of the truncal artery, initial conservative management is safe and allows management
of the major associated lesions. Stent grafting of the truncal artery is a valuable therapeutic alternative
to surgical repair, especially in patients considered to be a high risk for a conventional thoracotomy.

참고자료

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