颈部外伤30例临床分析

Clinical analysis of 30 cases of neck trauma

目的探讨颈部外伤的临床特点和救治方法。方法回顾性分析30例颈部外伤患者的临床资料,其中非手术治疗3例,单纯清创缝合3例,气管切开24例,下咽修复2例,喉成形8例,气管修复4例,食道修补2例,甲状腺缝扎4例,颈外动脉结扎3例,颈总动脉修补1例。结果 1例于入院时死亡,1例术后咽瘘,经鼻饲、局部换药、缝合治愈,2例损伤喉返神经者,声音嘶哑改善不明显,1例喉狭窄,带管出院,余26例均治愈。结论对颈部外伤的患者应把抢救生命放在首位,正确处理呼吸困难、出血及休克是治疗成功的关键,并尽可能恢复喉功能,防止并发症,同时还要注意有无合并多脏器损伤,有无基础疾病,采取有效的个体化综合治疗。

Objective To explore the clinical characteristics and treatment methods of neck trauma.Methods Clinical data of 30 cases with neck trauma were analyzed retrospectively.Among the 30 cases investigated,3 received non-surgical treatment,3 were treated with simple debridement suture,24 underwent tracheotomy;swallow repair was conducted on 2 cases,laryngeal forming on 8 cases,tracheal repair on 4 cases,esophagus repair on 2 cases,thyroid seam on 4 cases,external carotid artery ligation on 3 cases,and common carotid artery ligation on 1 case.Results 1 case died on admission.1 case developed pharyngeal fistula after operation and healed after nasal feeding,partial treatment and suture.For the 2 cases with recurrent laryngeal nerve injury,the voice hoarse improvement was not obvious.1 case with larygostenosis was discharged with tracheal catheter.The other 26 cases were cured.Conclusion The first important thing is to rescue lives of those with neck trauma.Treating breathing difficulties,hemorrhage and shock correctly is the key to success.Restoring laryngeal function and preventing complications should also be considered as far as possible.Pay attention to the presence of combined multiple organ damage and basic diseases and take effective individualized comprehensive treatment.