外伤性膈疝合并主动脉夹层的影像学特点及治疗策略：附3例报告,Journal of Cardiothoracic Surgery

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外伤性膈疝合并主动脉夹层的影像学特点及治疗策略：附3例报告
Journal of Cardiothoracic Surgery ( IF 1.5 ) Pub Date : 2023-01-27 , DOI: 10.1186/s13019-023-02117-4
Hao-Hao Wu ₁ , Shao-Song Tu ₂ , Fang-Biao Zhang ₂

Affiliation

外伤性主动脉夹层合并外伤性膈疝是一种罕见的外伤性疾病。本文旨在探讨外伤性膈疝伴主动脉夹层的影像学特点及治疗策略。回顾性分析3例创伤性膈疝合并主动脉夹层患者的影像学及临床资料。3例中，男性2例，女性1例；他们的平均年龄为 52.7 岁（范围 47-62 岁）。胸部 CT 扫描显示 2 例患者存在膈疝，但未发现外伤性主动脉夹层。所有患者均进行了膈疝修补术。术中探查发现主动脉扩张，术后增强CT证实主动脉夹层。1例患者行支架植入术后顺利康复（病例1）。另一例患者拒绝植入支架，死于胸腔出血（病例2）。第三名患者接受了术前增强 CT 以识别外伤性膈疝伴主动脉夹层（病例 3）。即刻进行主动脉覆膜支架置入术，择期行膈疝修补术。患者术后恢复良好。术前胸部 CT 平扫显示主要钝性胸部外伤患者有膈疝，有外伤史和主动脉周围间隙模糊，伴有积血和其他影像学表现。应进行胸部增强CT以提高主动脉夹层的诊断准确性。另一例患者拒绝植入支架，死于胸腔出血（病例2）。第三名患者接受了术前增强 CT 以识别外伤性膈疝伴主动脉夹层（病例 3）。即刻进行主动脉覆膜支架置入术，择期行膈疝修补术。患者术后恢复良好。术前胸部 CT 平扫显示主要钝性胸部外伤患者有膈疝，有外伤史和主动脉周围间隙模糊，伴有积血和其他影像学表现。应进行胸部增强CT以提高主动脉夹层的诊断准确性。另一例患者拒绝植入支架，死于胸腔出血（病例2）。第三名患者接受了术前增强 CT 以识别外伤性膈疝伴主动脉夹层（病例 3）。即刻进行主动脉覆膜支架置入术，择期行膈疝修补术。患者术后恢复良好。术前胸部 CT 平扫显示主要钝性胸部外伤患者有膈疝，有外伤史和主动脉周围间隙模糊，伴有积血和其他影像学表现。应进行胸部增强CT以提高主动脉夹层的诊断准确性。即刻进行主动脉覆膜支架置入术，择期行膈疝修补术。患者术后恢复良好。术前胸部 CT 平扫显示主要钝性胸部外伤患者有膈疝，有外伤史和主动脉周围间隙模糊，伴有积血和其他影像学表现。应进行胸部增强CT以提高主动脉夹层的诊断准确性。即刻进行主动脉覆膜支架置入术，择期行膈疝修补术。患者术后恢复良好。术前胸部 CT 平扫显示主要钝性胸部外伤患者有膈疝，有外伤史和主动脉周围间隙模糊，伴有积血和其他影像学表现。应进行胸部增强CT以提高主动脉夹层的诊断准确性。术前胸部 CT 平扫显示主要钝性胸部外伤患者有膈疝，有外伤史和主动脉周围间隙模糊，伴有积血和其他影像学表现。应进行胸部增强CT以提高主动脉夹层的诊断准确性。术前胸部 CT 平扫显示主要钝性胸部外伤患者有膈疝，有外伤史和主动脉周围间隙模糊，伴有积血和其他影像学表现。应进行胸部增强CT以提高主动脉夹层的诊断准确性。

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Imaging characteristics and treatment strategies of traumatic diaphragmatic hernia with aortic dissection: a report of 3 cases

Traumatic aortic dissection with traumatic diaphragmatic hernia is a rare traumatic disease. The purpose of this article is to investigate the imaging characteristics and treatment strategies for traumatic diaphragmatic hernia with aortic dissection. The imaging and clinical data of 3 patients with traumatic diaphragmatic hernia combined with aortic dissection were analyzed retrospectively. Of the three cases, two were males, and one was female; their mean age was 52.7 years (range, 47–62 years). Plain chest CT scans revealed diaphragmatic hernia in 2 patients, but no traumatic aortic dissection was found. Diaphragmatic hernia repair was performed in all patients. Aortic dilatation was found during intraoperative exploration, and aortic dissection was confirmed by postoperative enhanced CT. One patient underwent stent implantation and recovered smoothly (Case 1). The other patient refused stent implantation and died of thoracic hemorrhage (Case 2). The third patient underwent preoperative enhanced CT to identify traumatic diaphragmatic hernia with aortic dissection (Case 3). Aortic covered stent implantation was performed immediately, and diaphragmatic hernia repair was performed at a selected time. The patient’s postoperative recovery was good. A preoperative plain chest CT scan indicated diaphragmatic hernia in major blunt thoracic trauma patients with a history of trauma and blurred periaortic spaces accompanied by hematocele and other imaging manifestations. Chest-enhanced CT should be performed to improve the diagnostic accuracy of aortic dissection.

更新日期：2023-01-28

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