Leikensohn J, Milko D, Cotton R
Arch Otolaryngol. 1978 Jun;104(6):307-10. doi: 10.1001/archotol.1978.00790060009002.
Carotid artery ligation, whether elective or an emergency, is an operation that most head and neck surgeons do with some trepidation because of the possible neurologic consequences. Of 440 major head and neck operations for cancer in which the carotid artery was exposed, 20 (4.5%) patients suffered a carotid rupture or had the vessel ligated just prior to rupture. We describe the typical patient and his management. Of these 20 patients, five died as a direct result of rupture or ligation, ten survived rupture and/or ligation with neurologic sequelae, and five survived rupture and/or ligation without neurologica sequelae. Of the ten patients with neurologic problems, four had immediate strokes, and six had delayed strokes, ie, these occurred greater than eight hours after ligation. Seven patients who required carotid artery ligation, separate from the previously mentioned group, received 5,000 units of heparin sodium subcutaneously every 12 hours in a prospective study. Of these seven patients, one died immediately postoperatively, and six survived without any neurologic sequelae. We discuss the cause of delayed neurologic problems and the rationale for the use of low-dose heparin.
颈动脉结扎术，无论是择期手术还是急诊手术，都是大多数头颈外科医生在进行时会有所顾虑的手术，因为可能会产生神经方面的后果。在440例暴露颈动脉的头颈癌大手术中，有20例（4.5%）患者发生了颈动脉破裂或在破裂前进行了血管结扎。我们描述了这类典型患者及其治疗方法。在这20例患者中，5例因破裂或结扎直接死亡，10例在破裂和/或结扎后存活但有神经后遗症，5例在破裂和/或结扎后存活且无神经后遗症。在有神经问题的10例患者中，4例立即发生中风，6例发生延迟性中风，即这些中风发生在结扎后8小时以上。在与上述患者分开的7例需要进行颈动脉结扎的患者中，在一项前瞻性研究中，每12小时皮下注射5000单位肝素钠。在这7例患者中，1例术后立即死亡，6例存活且无任何神经后遗症。我们讨论了延迟性神经问题的原因以及使用低剂量肝素的理论依据。
