| 摘要: |
| 目的 总结6例11次颈部大动脉破裂出血的急救及血管修复重建经验。 方法 2002年12月至2008年12月我科共完成6例11次颈部大动脉破裂出血抢救,男性4例,女性2例,年龄12~67岁,中位年龄48岁。原发病为甲状腺癌术后双侧声带麻痹1例,甲状腺癌复发1例,甲状腺癌术后左侧声带麻痹1例,下咽癌复发1例,头颈部外伤1例,颈动脉体瘤1例。4例为二次手术,术后均给予放疗,放疗剂量60~80 Gy。11例次大出血中无名动脉破裂1例2次,颈总动脉4例8次,颈内动脉1例1次。术中大出血4例4次,血管修复术后再次破裂大出血4例6次,外伤1例1次。结果 充分暴露破裂血管后行血管修补5例次,人工血管移植吻合1例次,颈内动脉修剪后直接吻合1例次,大隐静脉重建2例次,颈总动脉结扎2例次。3例1次修复成功,1例2次修复成功,2例因放疗及感染原因血管修补重建后反复缝线脱落遂给予结扎。血管重建后采用胸大肌肌瓣3例、胸锁乳突肌2例保护颈部大动脉。全部病例均抢救成功,无围手术期死亡,1例因颈动脉结扎导致术后偏瘫。所有病例均完整随访,1例出院1周内再次大出血死亡,1例因肿瘤复发1年内死亡,1例存活3年以上至今,3例存活5年以上至今。结论 一旦发生颈部大动脉出血,先以手指压迫,切忌以血管钳盲目钳夹；迅速备血、补足血容量,积极抗休克治疗是抢救成功的前提；血管修复重建能有效防止术后出现神经系统并发症,需采用个体化血管修复方案；如无法修复重建可考虑颈总动脉结扎。 |
| 关键词: 颈动脉 血管重建 出血 结扎术 |
| DOI：10.3724/SP.J.1008.2012.00738 |
| 投稿时间：2012-04-20修订日期：2012-05-10 |
| 基金项目: |
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| Emergency rescue and vascular reconstruction of carotid artery rupture:a report of 6 cases |
| ZHU Min-hui, ZHENG Hong-liang, CHEN Shi-cai*, CHEN Dong-hui |
(Department of Otorhinolaryngology Head & Neck Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author.) |
| Abstract: |
| ObjectiveTo summarize our experience in rescuing fatal bleeding induced by carotid artery rupture(CAR) and in vascular reconstruction. MethodsSix patients (11 times) with CAR-induced fatal bleeding were treated in our department during Dec. 2002 to Dec. 2008. The patients included 4 males and 2 females, with an age range of 12-67 years old and a median of 48 years old. The primary illness included vocal cord paralysis (2 cases) after operation of thyroid carcinoma, recurrent thyroid carcinoma (1 case), recurrent hypopharyngeal carcinoma (1 case), head and neck trauma (1 case) and carotid body tumor(1 case). Four patients received radiotherapy (60-80 Gy) before second operation. One patient (2 times) had in-nominate artery blowout, 4 (8 times) had common carotid blowout, and one had internal carotid artery blowout. CAR occurred during or after surgical operations in 4 patients (8 times) and was caused by external injury in 1 case (1 time). ResultsRestore of CA after complete exposure of rupture was performed for 5 times, anastomosis by artificial blood vessel for 1 time, direct anastomosis for 1 time, reconstruction by great saphenous vein for 2 times, and ligation of total carotid artery for 2 times. Of all patients, 3 cases undergoing vascular reconstruction succeeded by one try, 2 by 2 tries, and 2 cases underwent ligation of artery because of suture falling off for radiotherapy of infection. Muscle flaps including pectoralis major myocutaneous flap ( 3 cases ) and sternocleidomastoid faps (2 cases) were used to protect vascular anastomosis. All cases were successfully rescued, without perioperative death. One patient developed hemiplegial after ligation of carotid artery. All cases had complete follow-up data. One patient died due to bleeding one week after discharge, 1 died due to recurrent tumor within one year after operation. By now one patient survived for 3 years and 3 for 5 years. ConclusionOnce CAP occurs, prompt press by hands and quick anti-shock procedure are the prerequisites of successful rescue. Reconstruction or repair of carotid artery can prevent complications of the nervous system, and individualized vascular reconstruction strategy should be employed. Ligation of carotid is effective to rescue patients of CAR, but it should only be chosen when reconstruction is impossible. |
| Key words: carotid arteries revascularization hemorrhage ligation |
