Colombo F, Sansonna F, Baticci F, Boniardi M, Di Lernia S, Ferrari G C, Pugliese R
Divisione di Chirurgia Generale e d'Urgenza, Azienda Ospedaliera di Niguarda Ca' Granda, Milano.
Ann Ital Chir. 2003 Mar-Apr;74(2):141-8.
Cervical lesions from penetrating trauma in the neck are increasing together with other types of trauma especially in big towns. Nevertheless in Italy a Register of Trauma is still lacking and no guidelines are available. Conservative management is also advocated and is still under discussion. Comparison of diagnostic tools and evaluation of different treatments in case of vascular damage is also expected.
A series of 16 penetrating lesions of the neck including various degrees of severity were treated over a span of 5 year. The penetrating trauma was due to stab wound or similar causes in 11 cases; to gunshot wound in 3 and to traffic accidents in 2 cases. All of them received surgical treatment. In 56% of cases (9/16) of cases vascular structures were involved, in 4 cases the aerodigestive tract was involved (25%), and in 1 the spinal cord was injured (6%) resulting in a Brown-Sequard syndrome. Other patients presented with superficial lesions, and reconstruction of muscles by simple suture or ligature of veins could obtain complete healing.
The penetrating trauma brought about death in 2 cases (1 stab wound, 1 gunshot wound), while 1 lesion of carotid artery and 4 lesions of jugular vein were successfully repaired. In 1 case of lesion in zone 3 a serious bleeding from damage to lingual artery was cured in spite of the minimal width of the external injury. Hypopharyngeal lesions could be treated in 2 cases. One was associated with lethal vascular damage. In 1 case of tracheal lesion with cervical hematoma and dyspnea, patency of the airways became the main concern and and a cannula was placed in the trachea. The Brown-Séquard syndrome could improve with rehabilitation therapy in 3 years. All of the minimal cervical lesions healed with uneventful course.
The penetrating trauma in the neck may show various degrees of severity: nevertheless, no cervical penetrating trauma should be underestimated in spite of the minimal width of the lesion. Surgical exploration was invariably the preferred treatment in our experience.
颈部穿透伤导致的颈部损伤与其他类型的创伤一样呈上升趋势，尤其是在大城市。然而在意大利，仍然缺乏创伤登记系统，也没有相关指南。保守治疗也受到提倡，且仍在讨论中。人们还期望对血管损伤情况下的诊断工具进行比较，并评估不同的治疗方法。
在5年的时间里，共治疗了16例颈部穿透伤，包括不同严重程度的损伤。11例穿透伤是由刺伤或类似原因引起的；3例是枪伤，2例是交通事故导致的。所有患者均接受了手术治疗。56%（9/16）的病例涉及血管结构，4例（25%）涉及气道消化道，1例（6%）脊髓受伤，导致布朗 - 塞卡尔综合征。其他患者表现为浅表损伤，通过简单缝合肌肉或结扎静脉即可实现完全愈合。
穿透伤导致2例死亡（1例刺伤，1例枪伤），而1例颈动脉损伤和4例颈静脉损伤成功修复。在1例3区损伤中，尽管外部损伤创口极小，但舌动脉损伤引起的严重出血得到了治愈。2例下咽损伤得到了治疗。其中1例伴有致命的血管损伤。在1例伴有颈部血肿和呼吸困难的气管损伤病例中，气道通畅成为主要问题，遂在气管内放置了插管。布朗 - 塞卡尔综合征在3年内通过康复治疗有所改善。所有轻微的颈部损伤均顺利愈合。
颈部穿透伤可能表现出不同程度的严重程度：然而，无论损伤创口多小，任何颈部穿透伤都不应被低估。根据我们的经验，手术探查始终是首选的治疗方法。
