颈部血管穿通伤22例的外科治疗  

Surgical management of penetrating cervical vascular trauma

作　　者：谭正力[1] 田然[1] 郁正亚[1] 

机构地区：[1]首都医科大学附属北京同仁医院血管外科,100730

出　　处：《中华医学杂志》2012年第27期1905-1908,共4页National Medical Journal of China

摘　　要：目的探讨颈部血管穿通伤的诊断和外科处理方法。方法回顾分析首都医科大学附属北京同仁医院2007年8月至2011年11月治疗的22例颈部大血管穿通性损伤的临床资料。结果22例患者共32处损伤，致伤原因为锐器伤12例，爆炸伤2例，医源性损伤8例。损伤部位分布：无名动脉1处，无名静脉2处，锁骨下动脉6处，锁骨下静脉2处，颈总动脉2处，颈内动脉3处，颈内静脉8处，颈外动脉4处，椎动脉4处。32处颈部血管损伤分布为Ⅰ区12处（38％），Ⅱ区19处（59％），Ⅲ区1处（3％）。4处椎动脉损伤中，1处位于V1段，2处位于V2段，1处位于V3段。22例患者分别采用单纯修补、单纯结扎、补片修补、自体血管间置移植以及腔内血管治疗，均存活。结论颈部血管穿通伤病情严重，死亡率高。对于具有明确血管损伤体征如血流动力学不稳定、活动性大出血以及血肿不断扩大的患者应立即急诊手术探查。对于血流动力学相对稳定的患者应进行影像学检查，对血管损伤进行评估后进行治疗。Objectives To discuss diagnosis and surgical management of penetrating cervical vascular trauma Methods A retrospective clinical analysis of 22 penetrating carotid artery injuries. Results Twenty-two patients presented 32 vascular injuries, including innominate artery （ n = 1 ）, innominate vein （ n = 2）, subclavian artery （ n = 6 ）, subclavian vein （ n = 2）, common carotid artery （ n = 3 ）, internal carotid artery （ n = 3 ）, external carotid artery （ n = 4）, jugular vein （ n = 8 ） and vertebral artery （ n = 4）. There were 12 patients with stab wounds, 2 with blast wound and 8 with iatrogenic injuries. Of these, there were 12 zone-1 injuries （38%）, 19 zonge-2 injuries （59%） and 1 zonge-3 injury （3%）. The distribution of 4 vertebral artery injuries were V1 （ n = 1 ）, V2 （ n = 2） and V3 （ n = 1 ）. All patient received surgical and endovascular managements and got survival. Conclusions Patients with penetrating cervical vascular injuries have high rate of mortality. Emergent surgical exploration is necessary for patients with hard signs of vascular injury such as hemodynamic instability, exsanguinating hemorrhage, or expanding hematoma. Those patients that are hemodynamically stable and who are without respiratory compromise should undergo further diagnostic imaging evaluation.

关 键 词：颈部创伤 动脉 静脉 影像诊断 

分 类 号：R653[医药卫生—外科学]