Journal of Trauma and Injury

  • 제22권1호
  • /
  • Pages.77-86
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  • 2009
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  • 2799-4317(pISSN)
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  • 2287-1683(eISSN)
대한외상학회 (The Korean Society of Traumatology)
권호 표지

체간부 장기 손상을 동반한 외상성 체간부 동맥 손상 환자의 치료 방침

Therapeutic Plan for Traumatic Truncal Arterial Injury Associated with Truncal Organ Injury

  • 조충현 (아주대학교 의과대학 응급의학교실) ;
  • 정용식 (아주대학교 의과대학 외과학교실) ;
  • 김욱환 (아주대학교 의과대학 외과학교실) ;
  • 조영신 (아주대학교 의과대학 응급의학교실) ;
  • 안정환 (아주대학교 의과대학 응급의학교실) ;
  • 민영기 (아주대학교 의과대학 응급의학교실) ;
  • 정윤석 (아주대학교 의과대학 응급의학교실) ;
  • 김성희 (아주대학교 의과대학 응급의학교실) ;
  • 이국종 (아주대학교 의과대학 응급의학교실)
  • Jo, Choong Hyun (Department of Emergeny Medicine, Ajou University School of Medicine) ;
  • Jung, Yong Sik (Department of Surgery, Ajou University School of Medicine) ;
  • Kim, Wook Hwan (Department of Surgery, Ajou University School of Medicine) ;
  • Cho, Young Shin (Department of Emergeny Medicine, Ajou University School of Medicine) ;
  • Ahn, Jung Hwan (Department of Emergeny Medicine, Ajou University School of Medicine) ;
  • Min, Young Gi (Department of Emergeny Medicine, Ajou University School of Medicine) ;
  • Jung, Yoon Seok (Department of Emergeny Medicine, Ajou University School of Medicine) ;
  • Kim, Sung Hee (Department of Emergeny Medicine, Ajou University School of Medicine) ;
  • Lee, Kug Jong (Department of Emergeny Medicine, Ajou University School of Medicine)
  • 투고 : 2009.04.30
  • 심사 : 2009.06.07
  • 발행 : 2009.06.30
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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.

키워드

참고문헌

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