Obeid F N, Haddad G S, Horst H M, Bivins B A
Surg Gynecol Obstet. 1985 Jun;160(6):517-22.
Over-all, the results of this review suggest that mandatory exploration for penetrating wounds of the neck may be safely supplanted by selective management. The basis for this conclusion includes: 1, most neck wounds were not associated with significant injury; 2, routine exploration did not obviate the possibility of missed injuries; 3, negative findings at exploration were associated with a number of complications; 4, hospital stay for patients with negative neck exploration results was similar to those with positive exploration findings, and 5, it appears that selective management should not increase the need for special diagnostic studies. Patients with clearly positive clinical findings indicating visceral neck injury should undergo operative exploration. Those with a negative clinical examination should be closely observed. Contrast roentgenographic and other special studies should be reserved for those with equivocal clinical findings or who have a change in clinical status under observation.
总体而言，本综述结果表明，对于颈部穿透伤，选择性处理可安全取代强制性探查。得出这一结论的依据包括：1. 大多数颈部伤口并无严重损伤；2. 常规探查并不能排除漏诊损伤的可能性；3. 探查结果为阴性与多种并发症相关；4. 颈部探查结果为阴性的患者住院时间与探查结果为阳性的患者相似；5. 似乎选择性处理不应增加特殊诊断检查的需求。临床检查结果明确呈阳性提示颈部脏器损伤的患者应接受手术探查。临床检查结果为阴性的患者应密切观察。对比影像学检查和其他特殊检查应保留给临床检查结果不明确或在观察过程中临床状况发生变化的患者。
