头部、颈部和胸部穿刺伤成功救治1例并文献复习  

Penetrating trauma of head, neck and chest: a case report and review of the literature

作　　者：祝源 孟亮[1] 樊文 王跃飞 涂勤[1] 曾浪 马廉亭 向伟楚 ZHU Yuan;MENG Liang;FAN Wen;WANG Yue-fei;TU Qin;ZENG Lang;MA Lian-ting;XIANG Wei-Chu(Department of Neurosurgery,Tongren Hospital of Wuhan University(Wuhan Third Hospital),Wuhan 430073,China;Department of Neurosurgery,General Hospital,Central Theater,PLA,Wuhan 430070,China)

机构地区：[1]武汉大学附属同仁医院(武汉市第三医院)神经外科,武汉430073 [2]中国人民解放军中部战区总医院神经外科,武汉430070

出　　处：《中国临床神经外科杂志》2020年第1期25-28,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨头部、颈部和胸部穿刺伤的术前评估和处理方法。方法 1例61岁女性因高空坠下的钢筋穿过头部、颈部和胸部。入院时昏迷,伴喷射样呕吐,生命体征平稳,不伴活动性出血。为了确定可能的血管损伤,行头颅CT和CTA检查,并进行影像融合处理,显示钢筋刚好避开头部、颈部和胸部重要的血管结构,于是在全麻下拔出钢筋,避免了颈部探查手术,最后复杂的头颈部探查手术变成了一个简单的创道清创手术。术中没有发现大的血管损伤,清除骨折片、毛发、血肿和破碎的脑组织,最后用生物胶封闭前颅窝底的出口。结果术后17 d出院,恢复良好,未遗留任何神经功能缺损。结论头部、颈部和胸部穿刺伤病情复杂,病死率和致残率高,其伤情评估和处理困难。CT平扫适合于初步伤情评估,CTA和三维影像融合可以准确评估血管损伤。经过术前仔细的评估,简单的拔除穿刺物也可以是一种治疗选择,可以避免复杂的颈部探查手术。Objective To explore the evaluation and management of penetrating trauma of head, neck and chest. Methods A 61-year-old woman suffered from the penetrating injury to the frontal region, right neck and anterior chest wall induced by iron rod falling from the high above the ground. The patient was in coma state with ejection vomiting. On initial examination, her vital signs were stable and there was no active bleeding from the penetrating site. The high resolution CT(HRCT) and CTA, and three-dimensional fused image showed that the iron rod just avoided the arteriovenous structures in the head, neck and anterior chest wall. The iron rod was gently removed, and the simple debridement of the trajectory was performed. The complex neck exploration was avoided. The defect of anterior skull base was sealed with biological glue. Result The patient was recovered without any neurologic defect. Conclusions HRCT is a suitable method to initially assess the injury condition, and the vascular injury can be assessed by CTA and three-dimensional fused image in the patient with penetrating injury, in whom the simple withdrawal of the thing producing the penetrating injury may be a choice of treatment of the penetrating trauma after the careful preoperative assessment.

关 键 词：颈部穿刺伤 术前评估 CT血管造影 三维影像融合 显微手术 

分 类 号：R651.15[医药卫生—外科学] R651.11[医药卫生—临床医学]