Sheely C H, Mattox K L, Reul G J, Beall A C, DeBakey M E
J Trauma. 1975 Oct;15(10):895-900. doi: 10.1097/00005373-197510000-00008.
Six hundred thirty-two cases of penetrating wounds of the neck were analyzed in this study in order to re-evaluate our current concepts in the management of these injuries. There were 35 deaths in this series, an overall mortality rate of 5.5%. However, in the last 10 years there were only 13 deaths among 407 patients, a 3.2% mortality rate. Early exploration was performed in 507 patients, and 125 patients were observed. Explorations revealed a total of 625 separate injuries. In 142 explorations, no injury was found. There was no mortality or significant morbidity in these patients with negative explorations. Patients who presented with obvious vascular or visceral injury were immediately explored. Those wounds without obvious injury were either explored or observed, depending on the index of clinical suspicion based on awareness of the innocuous presentation and difficulty in diagnosing esophageal injuries. The mortality rate is a function of multiple factors. Its decrease over the past 25 years is related to many improvements in our health care system. Our own decrease in mortality rate can be attributed in part to decreased transportation time resulting in less blood loss. A greater awareness of esophageal injuries was another factor. No conclusions are possible as to the feasibility of conservative management based upon the mortality rates alone; however, on examination of our experiences with penetrating wounds of the neck, it appears that a significant number of patients when carefully selected by trained personnel can be safely managed with observation.
本研究分析了632例颈部穿透伤病例，以重新评估我们目前对这些损伤的处理理念。该系列中有35例死亡，总死亡率为5.5%。然而，在过去10年中，407例患者中仅有13例死亡，死亡率为3.2%。507例患者进行了早期探查，125例患者进行了观察。探查共发现625处独立损伤。在142次探查中未发现损伤。这些探查阴性的患者无死亡或严重并发症。有明显血管或内脏损伤的患者立即进行探查。那些无明显损伤的伤口，根据对无害表现的认识以及食管损伤诊断的困难程度所产生的临床怀疑指数，要么进行探查，要么进行观察。死亡率是多种因素的函数。过去25年中死亡率的下降与我们医疗保健系统的许多改善有关。我们自己死亡率的下降部分可归因于运输时间的减少，从而减少了失血量。对食管损伤的更高认识是另一个因素。仅根据死亡率无法得出保守治疗可行性的结论；然而，根据我们对颈部穿透伤的经验，似乎经过训练的人员仔细挑选后，相当数量的患者可以通过观察得到安全处理。
