Chandrananth Meera L, Zhang Andrew, Voutier Catherine R, Skandarajah Anita, Thomson Benjamin N J, Shakerian Rezvaneh, Read David J
Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
ANZ J Surg. 2021 Jun;91(6):1083-1090. doi: 10.1111/ans.16600. Epub 2021 Jan 22.
Aim: to review outcomes of the 'no zone' approach to penetrating neck injuries (PNIs) with the advent of high-fidelity computed tomography-angiography (CT-A) in order to determine the most appropriate management for stable PNIs.
Systematic review.
Retrospective and prospective cohort studies of patients who sustained penetrating neck trauma, as defined by an injury which penetrates the platysma, and whose initial management involved CT-A evaluation.
An extensive literature search was performed in July 2019 using the following databases: Pubmed Central, EMBASE, Medline and Cochrane CENTRAL. Only studies published in English from the last 15 years were included.
Nine cohort studies met inclusion criteria. There has been an increase in CT-A focussed evaluation of PNIs in recent years. CT-A is a highly sensitive and specific imaging choice and reduces negative neck exploration rates. A new management algorithm for stable patients involving initial radiological assessment using CT-A, and subsequent selective surgical exploration, is safe and effective.
The results of this review provide level 2A evidence that the 'no zone' approach to PNIs, complemented by CT-A and thorough clinical assessment, is a safe management strategy which reduces negative neck exploration rates.
目的：随着高保真计算机断层扫描血管造影（CT-A）的出现，回顾穿透性颈部损伤（PNIs）的“无分区”治疗方法的结果，以确定对稳定的PNIs最合适的管理方法。
系统评价。
对遭受穿透性颈部创伤患者的回顾性和前瞻性队列研究，穿透性颈部创伤定义为穿透颈阔肌的损伤，其初始管理包括CT-A评估。
2019年7月使用以下数据库进行了广泛的文献检索：PubMed Central、EMBASE、Medline和Cochrane CENTRAL。仅纳入过去15年以英文发表的研究。
9项队列研究符合纳入标准。近年来，针对PNIs的CT-A重点评估有所增加。CT-A是一种高度敏感和特异的影像学选择，可降低颈部阴性探查率。一种针对稳定患者的新管理算法，包括使用CT-A进行初始放射学评估，随后进行选择性手术探查，是安全有效的。
本综述结果提供了2A级证据，即PNIs的“无分区”治疗方法，辅以CT-A和全面的临床评估，是一种安全的管理策略，可降低颈部阴性探查率。
