Reid J D, Weigelt J A, Thal E R, Francis H
Department of Surgery, Southwestern Medical School, University of Texas Health Science Center, Dallas 75235-9031.
Arch Surg. 1988 Aug;123(8):942-6. doi: 10.1001/archsurg.1988.01400320028004.
The use of angiography to evaluate penetrating extremity wounds with proximity to major vascular structures remains controversial. Arteriography in the asymptomatic patient with a penetrating extremity wound is reported to identify arterial injuries in 6% to 21% of patients; however, some injuries may have little clinical importance. This study attempted to determine the value of proximity as an indication for angiography. Five hundred seven asymptomatic patients with 534 penetrating extremity injuries underwent arteriography due to proximity to major vascular structures. Thirty-six arteriograms (6.7%) were positive. Seven patients did not undergo operative exploration, 19 patients (3.6%) had arteriograms, and ten (1.9%) had false-positive arteriograms. The remaining 498 patients had true-negative examination results. Arteriography was associated with 13 complications (2.6%). Proved vascular injury in the clinically asymptomatic patients in our series was extremely low (3.6%). These data make it difficult to justify arteriography due to proximity of injury to major vascular structures. However, it is difficult to abandon exclusion arteriography based on these retrospective data. These observations do suggest that better criteria to define proximity need to be identified.
利用血管造影术评估靠近主要血管结构的四肢贯通伤仍存在争议。据报道，在无症状的四肢贯通伤患者中，动脉造影可发现6%至21%的患者存在动脉损伤；然而，有些损伤可能临床意义不大。本研究试图确定靠近主要血管结构这一因素作为血管造影指征的价值。507例无症状患者因四肢贯通伤靠近主要血管结构而接受了动脉造影，共发生534处贯通伤。36例动脉造影结果为阳性（6.7%）。7例患者未接受手术探查，19例患者（3.6%）进行了动脉造影，其中10例（1.9%）动脉造影结果为假阳性。其余498例患者检查结果为真阴性。动脉造影相关并发症有13例（2.6%）。在我们的系列研究中，临床无症状患者经证实的血管损伤发生率极低（3.6%）。这些数据使得基于损伤靠近主要血管结构而进行动脉造影的做法难以得到合理的解释。然而，基于这些回顾性数据而放弃排除性动脉造影也很困难。这些观察结果确实表明，需要确定更好的标准来界定“靠近”这一概念。
