多発外傷における鈍的胸部大動脈損傷治療のタイミング(Timing of treatment for blunt thoracic aortic injury in cases of multiple trauma)

要旨 【目的】多発外傷における鈍的胸部大動脈損傷（BTAI）に対する治療のタイミングについて検討する。【対象】2011年から2018年に自施設で診療したBTAIのうち，AIS≥3または治療手技（手術あるいは血管内治療）を要する体幹部外傷を伴い，かつ侵襲的治療［ステントグラフト内挿術（SG）あるいは開胸手術（OS）］を行った25例を後方視的に検討した。【結果】48時間以内に侵襲的治療を施行した群は17例（68%，生存15例）で，48時間以降に施行した群の8例（32%，生存7例）と比較して入院期間が短く（43［31–55.5］日／64.5［61.5–82.75］日），RBC輸血量が少なかった（2［0–4］単位／8［4–19］単位）。待機期間がとくに長かった3例のうち2例はStanford B型のII型で，経過中に非手術的治療からSGへ変更したものだった。最終的に22例（88%）を救命した。BTAIの損傷形態は，日本外傷学会分類IIIbが1例でOSを施行，IIIaが18例（72%）で17例にSGが選択された。II型（IIaまたはIIb）は6例（24%）で，そのうちStanford A型の2例にはOSが，B型の4例にはSGが選択された。【結語】多発外傷におけるBTAIは48時間以内に侵襲的治療を行えば入院期間を短縮できRBC輸血量を減らすことができた。 ABSTRACT Aim: We attempted to clarify the timing of treatment for blunt thoracic aortic injury (BTAI) in cases of multiple trauma. Method: Twenty–five cases of BTAI with other severe injuries, treated with endovascular stent grafting (SG) or open surgery (OS) at our facility between 2011 and 2018, were examined retrospectively. Result: 22 cases (88%) were rescued. One case was classified as IIIb, according to The Japanese Association for The Surgery of Trauma, and OS was performed. Eighteen cases (72%) were classified as IIIa. SG was performed in 17 cases and OS in one case. Six cases (24%) were classified as II (IIa or IIb). Two cases were categorized as Stanford type–A aortic dissection and treated with OS. Four cases categorized as Stanford type–B were treated with SG. Seventeen cases (68%) were treated within 48 hours (early repair group). In those cases, the hospitalization period was shorter (43 days vs. 64.5 days) with lesser RBC transfusion compared to the 8 cases treated after forty–eight hours (delayed repair group). In two cases of the three cases with the longest waiting times, treatment was changed from non–operative management to SG. Conclusion: Invasive treatment for BTAI in multiple trauma cases should be performed within 48 hours to shorten the hospitalization period and reduce RBC transfusion.