穿透性颈部大血管伤的救治:附6例报道

A clinical study of large cervical vascular injury in penetrating neck trauma:Report of 6 cases

目的:探讨穿透性颈部大血管伤的救治方法。方法:1999—2010年收治6例穿透性颈部大血管伤患者,损伤的重要血管结构中颈内动脉1例,颈内静脉2例,椎动脉5例。6例患者中,5例行手术探查,1例为外伤性椎动脉假性动脉瘤,采用覆膜支架介入治疗。结果:6例患者均获得成功救治,所有患者存活,止血彻底,无继发性出血,无因脑部供血不足产生的功能障碍;2例患者颈部伤口延期愈合,分泌物非脓性,细菌培养无致病菌。结论:开放性颈部大血管伤以手术探查止血为首要治疗手段,损伤血管首选吻合,闭合性血管损伤介入血管重建值得推荐,椎动脉损伤手术填塞止血是有效的止血措施。

PURPOSE： To investigate the clinical diagnosis and therapy of large cervical vascular injury.METHODS： A retrospective review was made of 6 patients who had sustained large vascular injury to the neck,including one internal carotid artery,2 internal jugular veins,5 vertebral arteries.Surgical exploration was performed in 5 cases of penetrating cervical trauma,with one internal carotid artery and one internal jugular vein repaired,4 vertebral arteries packed with alternative materials.Another case with vertebral artery pseudoaneurysm was treated with covered stent graft.RESULTS： Good clinical results were gained in all 6 cases,without secondary hemorrhage.All patients keep alive,who got no secondary dysfunction for cerebral circulation insufficiency.CONCLUSIONS： Urgent surgical exploration was recommended in penetrating cervical vascular injuries,and the injured vessel should be repaired or reconstructed if possible.Packing hemostasis is an effective method in the treatment of vertebral artery injury.Endovascular treatment should be considered as a safe alternative in non-penetrating vascular injury.