Rivers S P, Patel Y, Delany H M, Veith F J
Dept. of Surgery, Bronx Municipal Hospital Center, Jacobi Hospital, NY 10461.
J Vasc Surg. 1988 Aug;8(2):112-6.
Of the patients with penetrating neck wounds treated between 1979 and 1986, 61 patients with 65 injuries had arteriography during their evaluation. Twenty-seven patients had stab wounds and 34 had gunshot wounds, with a relatively equal distribution between the zones of injury. Fifty-seven arteriograms were normal and six were abnormal. Of the six arteriographic defects, three were thought to be spurious on subsequent review, two were clinically insignificant, and one required surgery. No significant arterial injuries were identified by arteriography in the absence of suggestive physical findings. No major arterial injuries were discovered during neck surgery that were missed preoperatively. Neither abnormal nor normal angiograms significantly altered the course of management, including the approach to neck exploration. These data suggest that arteriography for penetrating neck trauma is usually unnecessary for observation of patients in stable condition without suggestive physical findings. Thorough neck exploration with dissection of the carotid sheath in patients with physical diagnostic criteria for surgery eliminates the need for angiography in most cases and avoids the consequences of a possible false-negative study.
在1979年至1986年期间接受治疗的穿透性颈部创伤患者中，61例患者共65处损伤在评估过程中接受了动脉造影检查。27例为刺伤，34例为枪伤，损伤区域分布相对均匀。57例动脉造影结果正常，6例异常。在随后的复查中，6例动脉造影缺陷中有3例被认为是假性的，2例临床上无意义，1例需要手术。在没有提示性体格检查结果的情况下，动脉造影未发现明显的动脉损伤。颈部手术期间未发现术前漏诊的主要动脉损伤。无论是异常还是正常的血管造影结果，均未显著改变治疗过程，包括颈部探查的方式。这些数据表明，对于病情稳定且无提示性体格检查结果的患者，穿透性颈部创伤的动脉造影通常没有必要。对于符合手术体格诊断标准的患者，彻底的颈部探查并解剖颈动脉鞘，在大多数情况下无需进行血管造影，避免了可能出现假阴性检查结果的后果。
