颈部血管严重损伤15例的治疗

The treatment of severe injuries of major jugular vessels with a report of 15 cases

目的总结颈部血管严重损伤的救治经验。方法回顾性分析利用无损伤血管缝合修补技术及利用自体颈外静脉移植行颈动脉重建、人工血管包绕等方法治疗 15例 (2 9条 )颈部血管严重损伤的临床资料。结果本组均救治成功并获随访 3～ 12周 ,平均随访 7 5周 ,修复血管通畅性良好。结论颈部血管严重损伤因失血、脑缺氧、窒息等死亡率高 ;保持呼吸道通畅、利用压迫和无损伤器械有效止血是成功救治的基础 ;娴熟的血管外科和显微外科技术 ,是救治成功的重要手段。

Objective To review the experience in managing severe major jugular vascular injuries. Methods Fifteen cases (11 men and 4 women, aged 18～49 years) treated by operation were collected. The injuried vessels included common carotid artery, internal carotid artery, subclavian artery and accompanying veins, carotid reconstruction was performed by jugular vein transplantation and followed by wrapping with PTFE artificial blood vessel in 15 cases. Result All the fifteen patients were cured and the vasculars were well-functioning 3～12 weeks after the surgery. Conclusion The mortality of severe large cervical vascular injuries is very high because of acute bleeding, cerebral ischimia and suffocation. In managing this catastrophe, keeping the airway clear and stop bleeding effectively are fundamental. Good knowledge and expertise in vascular and microvascular surgery are mandatory for the success of the procedure.