鼻内镜手术中颈动脉损伤：危险因素、预防及处理
Carotid artery injury in endoscopic endonasal surgery: Risk factors, prevention, and management.
作者信息
Sharma Rahul K, Irace Alexandria L, Overdevest Jonathan B, Gudis David A
机构信息
Department of Otolaryngology-Head and Neck Surgery Columbia University Irving Medical Center, NewYork-Presbyterian Hospital New York New York USA.
Department of Otolaryngology-Head and Neck Surgery Vanderbilt University Medical Center Nashville Tennessee USA.
出版信息
World J Otorhinolaryngol Head Neck Surg. 2022 Mar 22;8(1):54-60. doi: 10.1002/wjo2.7. eCollection 2022 Mar.
OBJECTIVE
Endoscopic approaches for sinus and skull base surgery are increasing in popularity. The objective of this narrative review is to characterize risk factors for internal carotid artery injury in endoscopic endonasal surgery (EES), highlight preventative measures, and illustrate key management principles.
DATA SOURCES
Comprehensive literature review.
METHODS
Relevant literature was reviewed using PubMed/MEDLINE.
RESULTS
Carotid artery injury in EES is rare, with most studies reporting an incidence below 0.1%. Anatomic aberrancies, wide dissection margins, as well as specific provider and hospital factors, may increase the risk of injury. Multidisciplinary teams, comprehensive preoperative imaging, patient risk assessment, and formal training in vascular emergencies may reduce the risk. Management protocols should emphasize proper visualization of the injury site, fluid replacement, rapid packing, angiography, and endovascular techniques to achieve hemostasis.
CONCLUSIONS
While EES is a relatively safe procedure, carotid artery injury is a devastating complication that warrants full consideration in surgical planning. Important preventative measures include identifying patients with notable risk factors and obtaining preoperative imaging. Multidisciplinary teams and management protocols are ultimately necessary to reduce morbidity and mortality.
目的
鼻窦和颅底手术的内镜入路越来越受欢迎。本叙述性综述的目的是描述内镜鼻内手术（EES）中颈内动脉损伤的危险因素，强调预防措施，并阐明关键的处理原则。
数据来源
全面的文献综述。
方法
使用PubMed/MEDLINE对相关文献进行综述。
结果
EES中颈动脉损伤很少见，大多数研究报告的发生率低于0.1%。解剖变异、广泛的手术切缘以及特定的术者和医院因素可能会增加损伤风险。多学科团队、全面的术前影像学检查、患者风险评估以及血管急症的正规培训可能会降低风险。处理方案应强调对损伤部位的恰当可视化、液体补充、快速填塞、血管造影以及实现止血的血管内技术。
结论
虽然EES是一种相对安全的手术，但颈动脉损伤是一种灾难性并发症，在手术规划中值得充分考虑。重要的预防措施包括识别有显著危险因素的患者并进行术前影像学检查。多学科团队和处理方案对于降低发病率和死亡率最终是必要的。
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