颈部外伤的诊治体会

Experience in diagnosis and treatment of cervical trauma

目的回顾性分析颈部外伤患者的临床资料,对其发病原因、诊断及治疗过程进行分析,总结经验与体会。方法收集南京市第一医院耳鼻咽喉科2008年9月～2017年9月收治的颈部外伤患者19例,其中男15例,女4例;年龄18～87岁,平均年龄46. 4岁,病程0. 5 h至2个月。19例患者中颈部异物9例(6例金属异物、3例玻璃异物)、开放性颈部外伤8例、闭合性颈部外伤2例。根据患者不同的发病原因及病情,选择不同的麻醉方式及治疗方法。结果 19例患者伤口均愈合良好,随访6个月,无死亡病例,无气管及食管瘘,仅1例并发一定程度的声音嘶哑。结论在颈部外伤的诊治中,保持呼吸道通畅、止血、纠正失血性休克是关键,其次进行异物清除、喉气管功能重建及血管、神经吻合,减少术后功能损失。

Objective To analyze the etiology,diagnosis and treatment process of cervical trauma,and sum up our experiences via retrospective analysis on the clinical data of patients. Methods 19 patients of cervical trauma treated in our department from Sept 2008 to Sept 2017 were included. Of them,15 were male and 4 were female,aged from 18 to 87 years old with an average age of 46. 4. The course of disease was half an hour to 2 months. As for the causes of trauma,cervical foreign body existed in 9 cases（ metal foreign body in 6,and glass foreign body in 3）,open trauma in 8 and closed trauma in 2. Different anesthesia and treatment methods were selected according to the causes and patients ＇conditions. Results Good wound healing was achieved in all the 19 patients. Follow-up for 6 months showed neither death nor tracheoesophageal fistula,except hoarseness in one case. Conclusions For the diagnosis and treatment of cervical trauma,it is the key to maintain airway patency,stop bleeding,and correct hemorrhagic shock. Secondly,foreign body removal,laryngotracheal function reconstruction,vascular and neurological anastomosis should be performed to reduce postoperative functional loss.