University of Pittsburgh Medical Center Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA.
Northeast Ohio Medical University, University of Pittsburgh, Pittsburgh, PA, USA.
Am J Otolaryngol. 2022 Mar-Apr;43(2):103360. doi: 10.1016/j.amjoto.2021.103360. Epub 2021 Dec 24.
Head and neck surgery encompasses major vessels, raising the concern of life-threatening complications such as stroke.
Databases at UPMC were queried to identify patients with both neck dissections and stroke from January 1st, 2004, to October 1st, 2020. A retrospective chart review was performed to identify patients who experienced a stroke within 30 days of a neck dissection.
Search of a UPMC database for carotid artery stenosis (CAS), transient ischemic attack (TIA), and stroke identified 20,527 patients. After matching with the Head and Neck Tumor Registry patients, 41 of 4230 patients with a neck dissection also had a stroke, TIA, or CAS in their lifetime. One patient, with multiple risk factors, despite pre-operative precautions, had a stroke 2 days post neck dissection in the setting of carotid occlusion from hypercoagulability of malignancy and intraoperative vessel injury. The patient subsequently underwent a carotid thrombectomy and vein patch repair and has had no additional cerebrovascular accidents.
Although the incidence of stroke post neck dissection is minimal, patients with multiple risk factors for stroke should be managed carefully to prevent deleterious outcomes.
头颈部手术涉及到大血管，这引发了对危及生命的并发症（如中风）的担忧。
UPMC 的数据库被查询，以确定 2004 年 1 月 1 日至 2020 年 10 月 1 日期间既有颈部解剖又有中风的患者。进行了回顾性图表审查，以确定在颈部解剖后 30 天内发生中风的患者。
在 UPMC 数据库中搜索颈动脉狭窄（CAS）、短暂性脑缺血发作（TIA）和中风，共确定了 20527 名患者。与头颈部肿瘤登记患者匹配后，在 4230 名接受颈部解剖的患者中，有 41 名患者在其一生中曾发生过中风、TIA 或 CAS。尽管有多个术前预防措施，但一名患者仍因恶性肿瘤高凝状态和术中血管损伤导致颈动脉闭塞，在颈部解剖后 2 天发生中风。该患者随后接受了颈动脉血栓切除术和静脉补片修复，此后没有发生其他脑血管意外。
尽管颈部解剖后中风的发生率很低，但应仔细管理有多种中风危险因素的患者，以防止不良后果。
