外伤性颈动静脉瘘的外科治疗

SURGICAL TREATMENT OF TRAUMATIC CAROTID ARTERIO-VENOUS FISTULA

本文报道外伤性颈动静脉瘘6例。全组病例均有颈部穿透伤病史,5例有颈部搏动性肿块。有4例进行了手术治疗,其中3例作动静脉瘘切除及动、静脉侧壁修补术,1例作经静脉修补动脉及动静脉瘘切除术。作者认为本病最理想的治疗方法是切除动静脉瘘并作颈动脉及颈静脉修补术;手术时机以外伤后48小时以内为最好,若此时不能手术,则应在3~4周后(局部急性水肿消退后)再考虑手术。

Six male patients, 21-40 years old, were admitted for traumatic carotid arteriovenous fistula from 1960 through 1980. All patients had a history of penetrating injury in the neck followed by appearance of an enlarging pulsating mass with machinery bruit. Compression of the carotid proximal to the fistula could abolish the bruit. Of the 6 cases, 2 refused operation, 3 were treated by excision of the A-V fistula and repair of the artery and vein, and 1 by repair of A-V fistula through vein and excision of the fistula. Operation should be performed either within 48 hours after injury or 3-4 weeks later when the acute inflammatory reaction subsided. We consider resection of the fistula with repair of the carotid artery and the jugular vein is the method of choice.