Noyes L D, McSwain N E, Markowitz I P
Ann Surg. 1986 Jul;204(1):21-31. doi: 10.1097/00000658-198607000-00003.
Of 193 patients with penetrating wounds of the neck, 76 had only surgical exploration; 57 had only nonsurgical exploration including one or more of the following: arteriography, bronchoscopy, laryngoscopy, esophagoscopy, and contrast-swallow esophagogram; and 60 had both surgical and nonsurgical exploration. Eighty-six patients were wounded by gunshot, 108 by stabbing. Presenting signs and symptoms were an unreliable method of predicting presence or absence of injury. Overall negative rate of surgical exploration was 50% (54% of the stabbings and 45% of the gunshots). Accuracy of nonsurgical exploration was assessed by comparing to surgery. Arteriography was 100% accurate, a combination of bronchoscopy and laryngoscopy was 100% accurate, contrast-swallow esophagogram was 90% accurate, and esophagoscopy was 86% accurate. The literature was reviewed regarding the accuracy of nonsurgical as well as surgical exploration. The one complication attributed to nonsurgical exploration was a symptomatic anemia, while there were two wound infections resulting in increased length of stay associated with negative surgical exploration. Overall mortality rate was 5.6%. The average length of stay for nonsurgical exploration only was 2.8 days, for negative surgical exploration was 4.2 days, and for positive surgical exploration was 9.5 days. Financial cost of a negative surgical exploration was $3185, while for four-vessel cerebral arteriography with panendoscopy it was $3492. More studies need to be done, particularly concerning venography and esophagoscopy. However, considering the fact that surgical exploration should by no means be considered 100% accurate, the data in this study support the fact that arteriography with panendoscopy represents an equally safe and acceptable method of exploration of penetrating wounds of the neck for stable patients without specific signs and symptoms of injury and can be expected to result in a reduced number of negative surgical explorations and their associated morbidity as well as a reduced length of hospital stay, although at a slightly higher financial cost when compared to mandatory surgical exploration.
在193例颈部穿透伤患者中，76例仅接受了手术探查；57例仅接受了非手术探查，包括以下一项或多项：动脉造影、支气管镜检查、喉镜检查、食管镜检查和食管造影吞咽检查；60例同时接受了手术和非手术探查。86例患者因枪伤受伤，108例因刺伤受伤。呈现的体征和症状并不是预测有无损伤的可靠方法。手术探查的总体阴性率为50%（刺伤患者中为54%，枪伤患者中为45%）。通过与手术结果对比来评估非手术探查的准确性。动脉造影的准确率为100%，支气管镜检查和喉镜检查联合应用的准确率为100%，食管造影吞咽检查的准确率为90%，食管镜检查的准确率为86%。对关于非手术和手术探查准确性的文献进行了综述。归因于非手术探查的一项并发症是症状性贫血，而有两例伤口感染导致与阴性手术探查相关的住院时间延长。总体死亡率为5.6%。仅接受非手术探查的患者平均住院时间为2.8天，阴性手术探查患者为4.2天，阳性手术探查患者为9.5天。阴性手术探查的财务成本为3185美元，而四血管脑动脉造影联合全内镜检查的成本为3492美元。需要开展更多研究，特别是关于静脉造影和食管镜检查的研究。然而，考虑到手术探查绝不应被视为100%准确这一事实，本研究中的数据支持以下事实：对于没有特定损伤体征和症状的稳定患者，动脉造影联合全内镜检查是一种同样安全且可接受的颈部穿透伤探查方法，有望减少阴性手术探查的数量及其相关发病率，以及缩短住院时间，尽管与强制手术探查相比，财务成本略高。
