摘要
目的探讨口腔颌面颈部创伤性假性动脉瘤的病因、临床诊断、围术期准备及救治等。方法回顾近三年我院颌面创伤整形外科收治的创伤性假性动脉瘤患者6例,分析其形成原因、临床特点及诊断治疗方法。结果所有患者经彩色多普勒超声检查发现,受伤血管周围有明显漩涡形成;并根据患者病情行CTA、MRI、DSA及经股动脉插管造影等检查进一步明确诊断;6例患者中有2例行局部组织清创,并结扎受损血管,1例因颈内动脉闭锁行保守治疗、1例应用介入法行支架植入封堵治疗,其余患者均采用修补或结扎受损颈外动脉的方法治疗,治疗后所有患者均痊愈,无意外死亡,未出现其他新的明显并发症。结论创伤是造成颌面颈部创伤性假性动脉瘤的主要原因;对急诊患者而言,创伤性假性动脉瘤常具有发病急、症状重、潜在危险性高、并常伴有邻近周围神经功能障碍、张口受限及骨折等症状;对常规入院患者,其假性动脉瘤症状常被其他症状所掩盖,具有隐匿性较强、易被忽视的特点。故临床上应密切结合致伤原因、血管损伤的临床表现、诊断要点及影像学检查等,即可对创伤性假性动脉瘤进行诊断及鉴别诊断,提高诊断准确率,而及早诊断和有效的治疗是挽救患者生命的关键。
Objective To explore the diagnosis and treatment of traumatic pseudoaneurysm in maxillofacial and neck region. Methods 6 patients with traumatic pseudoaneurysm admitted to our department were analyzed retrospectively. Results Inflammation and unsuitable treatment was the cause of 1 case, 3 cases were stabbed by knife, 1 case were injured by gunshot, 1 patient was related with branch injury. Obvious wound was or was not found in these patients. All the patients were swollen in face and neck regions, and at the same time with or without nerve symptoms, bone fracture, fistula of parotid gland and other symptoms. Color Doppler ultrasound was performed and obvious whirling fluid was found in all the patients. Digital subtraction angiography （ DSA ）, MRI, CT angiography and transfemoral catheterization arteriography （TCA） was selected to define the diagnosis. Debridement of local tissues and artery ligation were performed in 2 cases. 1 patient accepted conservative therapy because of the entire blockage of internal carotid artery. DSA embolism was performed in 1 case. Other patients were treated by the ligation or repair of the injured artery. All the patients were cured without any other serious complications. Conclusions Pseudoaneurysm in maxillofacial and neck region was mainly caused by inflammation and injury. Burst and bleeding of pseudoaneurysm in maxillofacial and neck region is the cause of high mortality. To improve the knowledge and vigilance for this disease, early diagnosis and effective treatment of the injured artery are key methods to rescue the patients.
出处
《中国急救医学》
CAS
CSCD
北大核心
2008年第3期251-253,共3页
Chinese Journal of Critical Care Medicine
关键词
创伤
假性动脉瘤
颌面颈部
救治
Trauma
Pseudoaneurysm
Maxillofacial and neck region
Treatment
