Naude G P, Bongard F S
Department of Surgery, Harbor-UCLA Medical Center, UCLA School of Medicine, Torrance, USA.
J R Coll Surg Edinb. 1998 Apr;43(2):122-4.
Zone three carotid injuries present problems of access in emergency situations. Not only are the methods time consuming, but they also put certain structures in the neck at risk. A patient was treated at this institution with a large calibre gunshot injury of the right internal carotid and internal jugular vein. He was neurologically intact and his bleeding had been completely controlled. A decision was made to treat him conservatively and he recovered uneventfully with no neurological deficit and no further bleeding. Emergency exposure of the distal carotid artery involves dislocating the mandible, putting the facial nerve and parotid gland at risk of injury. Base of skull carotid injuries are best treated expectantly if there is no active bleeding or progressive neurological impairment. Careful follow-up is required to diagnose and treat carotid-jugular fistulas, false aneurysms and stenoses early.
三区颈动脉损伤在紧急情况下存在暴露问题。这些方法不仅耗时，而且还会使颈部的某些结构处于危险之中。本机构曾治疗过一名患者，其右侧颈内动脉和颈内静脉遭受大口径枪伤。他神经功能完好，出血已完全得到控制。决定对其进行保守治疗，他顺利康复，没有神经功能缺损，也没有再次出血。紧急暴露远端颈动脉需要使下颌骨脱位，从而使面神经和腮腺有受伤的风险。如果没有活动性出血或进行性神经功能损害，颅底颈动脉损伤最好采取保守治疗。需要仔细随访以便早期诊断和治疗颈动脉 - 颈静脉瘘、假性动脉瘤和狭窄。
