颈部复合性外伤的急救处理

目的总结严重颈部复合伤患者的救治经验。方法回顾性分析2001年2月至2007年2月收治的43例严重颈部复合伤患者的临床资料。结果根据病变程度和范围,结扎颈总动脉1例,颈内动脉3例;聚四氟乙烯人造血管修复颈内动脉3例。气管内插管22例次,紧急气管切开21例次。喉气管功能的一期重建19例(喉气管单纯整复术12例,气管袖状切除加气管端端吻合4例,胸锁乳突肌锁骨骨膜瓣修补气管3例),喉全切除术1例。胸锁乳突肌修补气管食管瘘3例。43例患者存活40例,死亡3例,其中2例因颈内动脉破裂术后多脏器衰竭死亡,因呼吸道梗阻窒息死亡1例。气管食管瘘修补3例均痊愈。后遗症:7例颈动脉修复或结扎的患者中3例术后出现偏瘫失语。19例喉气管功能的一期重建后遗留喉狭窄及声嘶5例,其中2例严重喉气管狭窄患者长期带气管套管1例,1例经记忆金属支架植入治疗好转。舌下神经和迷走神经损伤各2例,颈交感神经损伤1例,副神经麻痹5例,舌下神经和副神经均损伤2例。结论紧急处理大出血,呼吸困难及失血性休克是颈部外伤抢救成功的关键。早期正确处理颈部重要器官可避免喉气管狭窄和神经系统并发症的发生。

Emergency treatment for complex neck trauma

Objective To summarize the experience in emergency treatment of complex neck trauma.Methods The clinical data of 43 patients with severe compound neck trauma,36 males and 7 females,aged 36(19~72),treated between 2001 and 2007 were retrospectively analyzed.Results Different kinds of surgical modalities were performed according to the extent and degree of t complex neck trauma.The common carotid artery was ligated in one patient and the internal carotid artery was ligated in three patients.In three patients the injury of the internal carotid artery was repaired with interposition polytetrafluoroethylene grafts.Emergent airway management included endotracheal intubation(22 case-times) and emergent tracheostomy(21 case-times).Immediate reconstruction of the laryngotracheal function was conducted in 19 patients(immediate reconstruction with restoration of the laryngotracheal framework and mucosal integrity in 12 patients,tracheal segmental resection with end-to-end anastomosis in 4,and sternocleidomastoid myoperiosteal flap for the repair of tracheal wall defects in 3),and total laryngectomy was conducted in one patient.Trauma tracheoesophageal fistula was repaired by sternocleidomastoid muscle flap in 3 patients.Forty of the 43 patients survived and three died,of which 2 with common carotid artery rupture died of multiple organ failure after surgery,and the other one died of airway obstruction.The traumatic tracheoesophageal fistulae in 3 patients were successful repaired by sternocleidomastoid muscle flap.The postoperative sequelae were laryngotracheal stenosis and cranial nerve deficits.Three of the 7 patients undergoing arterial reconstruction because of traumatic carotid artery injury developed hemiparesis and aphasia.Laryngotracheal stenosis and hoarseness were present in 5 of the 19 patients undergoing laryngotracheal reconstruction.In two patients with serious laryngotracheal stenosis,one had long-term tracheal cannula,and the other was treated with retention metal rack implant.Neuropathy of the cranial nerves was identified in 10 patients(2 patients had injuries to the hypoglossal nerve,2 to the vagus,1 to the cervical sympathetic nerve,and 5 to the spinal accessory nerve,two patients presented with coexistent palsies to the hypoglossal nerve and the spinal accessory nerve).Conclusion The successful rescue key is the emergency treatment to massive hemorrhage,dyspnea,respiratory distress and hemorrhagic shock in the patients with cervical traumas.The appropriate treatment in the early stage is essential in the treatment of the cervical important organs with injuries and helps avoid the traumatic laryngotracheal stenosis and neurological complications.