中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2012年
27期
1905-1908
,共4页
颈部创伤%动脉%静脉%影像诊断
頸部創傷%動脈%靜脈%影像診斷
경부창상%동맥%정맥%영상진단
Neck injury%Arteries%Veins%Diagnostic imaging
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.
目的 探討頸部血管穿通傷的診斷和外科處理方法.方法 迴顧分析首都醫科大學附屬北京同仁醫院2007年8月至2011年11月治療的22例頸部大血管穿通性損傷的臨床資料.結果 22例患者共32處損傷,緻傷原因為銳器傷12例,爆炸傷2例,醫源性損傷8例.損傷部位分佈:無名動脈1處,無名靜脈2處,鎖骨下動脈6處,鎖骨下靜脈2處,頸總動脈2處,頸內動脈3處,頸內靜脈8處,頸外動脈4處,椎動脈4處.32處頸部血管損傷分佈為Ⅰ區12處(38％),Ⅱ區19處(59％),Ⅲ區1處(3％).4處椎動脈損傷中,1處位于V1段,2處位于V2段,1處位于V3段.22例患者分彆採用單純脩補、單純結扎、補片脩補、自體血管間置移植以及腔內血管治療,均存活.結論 頸部血管穿通傷病情嚴重,死亡率高.對于具有明確血管損傷體徵如血流動力學不穩定、活動性大齣血以及血腫不斷擴大的患者應立即急診手術探查.對于血流動力學相對穩定的患者應進行影像學檢查,對血管損傷進行評估後進行治療.
목적 탐토경부혈관천통상적진단화외과처리방법.방법 회고분석수도의과대학부속북경동인의원2007년8월지2011년11월치료적22례경부대혈관천통성손상적림상자료.결과 22례환자공32처손상,치상원인위예기상12례,폭작상2례,의원성손상8례.손상부위분포:무명동맥1처,무명정맥2처,쇄골하동맥6처,쇄골하정맥2처,경총동맥2처,경내동맥3처,경내정맥8처,경외동맥4처,추동맥4처.32처경부혈관손상분포위Ⅰ구12처(38％),Ⅱ구19처(59％),Ⅲ구1처(3％).4처추동맥손상중,1처위우V1단,2처위우V2단,1처위우V3단.22례환자분별채용단순수보、단순결찰、보편수보、자체혈관간치이식이급강내혈관치료,균존활.결론 경부혈관천통상병정엄중,사망솔고.대우구유명학혈관손상체정여혈류동역학불은정、활동성대출혈이급혈종불단확대적환자응립즉급진수술탐사.대우혈류동역학상대은정적환자응진행영상학검사,대혈관손상진행평고후진행치료.
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.
