Robbs J V, Reddy E
Department of Surgery, University of Natal, Durban, Republic of South Africa.
Surg Gynecol Obstet. 1987 Oct;165(4):323-6.
Between January 1984 and January 1986, 74 patients were treated for stab or gunshot injury to the great veins in the neck and superior mediastinum. Veins involved in the neck were the subclavian and internal jugular and in the mediastinum, the brachiocephalic and subclavian vein and the superior vena cava. Most patients presented in a state of shock. Twenty-nine were bleeding too rapidly to resuscitate adequately and required emergency operation while in a moribund state. Twenty-five had arteriovenous fistulas and were hemodynamically stable. Direct venous repair was attempted if simple lateral suture or end to end anastomosis could be rapidly done. If complex repairs were required, ligation was performed. Fifty-five veins were ligated on this basis, including 14 brachiocephalic trunks, nine proximal subclavian veins and one superior vena cava cephalad to the azygos. Nineteen were repaired. Two patients died after ligation and one patient after repair, all as a result of the effects of massive hypovolemia. Edema of the upper limb developed in two patients in each treatment group in whom the distal part of the subclavian vein had been involved. The edema resolved within five to seven days. Chronic venous stasis problems did not develop in any patient during the two to 26 month follow-up period.
1984年1月至1986年1月期间，74例患者因颈部和上纵隔大静脉受到刺伤或枪伤而接受治疗。颈部受累的静脉为锁骨下静脉和颈内静脉，纵隔内受累的静脉为头臂静脉、锁骨下静脉和上腔静脉。大多数患者就诊时处于休克状态。29例出血速度过快，无法充分复苏，需要在濒死状态下进行急诊手术。25例患有动静脉瘘，血流动力学稳定。如果能迅速完成简单的侧方缝合或端端吻合，就尝试进行直接静脉修复。如果需要进行复杂修复，则进行结扎。在此基础上，结扎了55条静脉，包括14条头臂干、9条近端锁骨下静脉和1条奇静脉上方的上腔静脉。19条静脉得到修复。2例患者结扎后死亡，1例患者修复后死亡，均因大量失血的影响。在每个治疗组中，锁骨下静脉远端受累的2例患者出现了上肢水肿。水肿在5至7天内消退。在2至26个月的随访期内，没有任何患者出现慢性静脉淤滞问题。
