Michelassi F, Pietrabissa A, Ferrari M, Mosca F, Vargish T, Moosa H H
Department of Surgery, University of Chicago, Ill.
Surgery. 1990 Mar;107(3):239-45.
The rarity of bullet emboli leads to frequent delays in diagnosis and inadequate early management. Our recent experience with this entity is described, and 153 cases reported in the English-language literature are reviewed and summarized. The majority of cases occurs as a consequence of civilian violence among men in their 20s and 30s. Most bullet emboli follow the direction of blood flow, although 15% of venous bullets cause embolization in a retrograde manner. One in 10 arterial emboli follow a right-heart or venous injury. Arterial bullets are symptomatic in 80% of cases, venous bullets in only one third. The choice of surgical management must be individualized according to the symptoms caused by the bullet and its location in the vascular system. In general, arterial bullet emboli are removed because of symptoms or findings of acute peripheral ischemia. Arterial and venous emboli not causing symptoms should be removed according to the risk of possible displacement and further embolization. Selective intraoperative angiograms and phlebograms can precisely localize the migrating bullet and permit appropriate placement of incisions before removal.
子弹栓子极为罕见，常导致诊断延误和早期治疗不足。本文描述了我们近期处理该病症的经验，并对英文文献中报道的153例病例进行了回顾和总结。大多数病例是由二三十岁男性的平民暴力事件导致的。多数子弹栓子顺血流方向移动，不过15%的静脉子弹会逆行导致栓子形成。十分之一的动脉栓子继发于右心或静脉损伤。80%的动脉子弹病例有症状，而静脉子弹病例只有三分之一有症状。手术治疗方案的选择必须根据子弹所致症状及其在血管系统中的位置进行个体化制定。一般而言，因急性外周缺血的症状或表现而取出动脉子弹栓子。对于未引起症状的动脉和静脉栓子，应根据可能移位和进一步形成栓子的风险予以取出。选择性术中血管造影和静脉造影可精确确定游走子弹的位置，并在取出前允许适当切口定位。
