McIntyre W B, Ballard J L
Division of Vascular Surgery, Loma Linda University Medical Center, CA 92354, USA.
Semin Vasc Surg. 1998 Dec;11(4):232-42.
Arterial and venous trauma of the cervicothoracic region continues to present challenging problems for the surgeon, despite advances in vascular diagnostics and surgical technique. Whether due to penetrating or blunt mechanisms, overall incidence of these injuries is low, whereas morbidity and mortality remain high. Despite collective experience from busy trauma centers, there still remain controversies regarding diagnostic evaluation, operative approach, and surgical treatment of these potentially devastating injuries. Therefore, this article compares and contrasts recent literature and controversies surrounding the treatment of cervicothoracic trauma. Pros and cons of duplex ultrasonography and angiography in the diagnosis of carotid and vertebral artery injury are highlighted, and selective versus mandatory neck exploration for zone II penetrating injuries are discussed. Increasing awareness of blunt carotid artery injury is emphasized, including management dilemmas that frequently accompany this type of injury. In addition, we review interventional radiological techniques for the management of vertebral artery injury and surgical approaches for aortic arch branch vessel or major cervicothoracic vein injury.
尽管血管诊断技术和外科手术技术取得了进步，但颈胸段动静脉创伤对外科医生来说仍然是具有挑战性的问题。无论是穿透性还是钝性机制导致的损伤，这些损伤的总体发生率较低，而发病率和死亡率仍然很高。尽管繁忙的创伤中心积累了丰富的经验，但对于这些潜在的严重损伤的诊断评估、手术入路和外科治疗仍存在争议。因此，本文比较和对比了近期关于颈胸段创伤治疗的文献及争议。重点介绍了双功超声和血管造影在诊断颈动脉和椎动脉损伤中的优缺点，并讨论了Ⅱ区穿透伤的选择性与强制性颈部探查。强调了对钝性颈动脉损伤认识的提高，包括这类损伤常伴随的处理难题。此外，我们还综述了治疗椎动脉损伤的介入放射学技术以及主动脉弓分支血管或颈胸段主要静脉损伤的手术方法。
