颈动脉损伤诊断与治疗进展

doi:10.6040/j.issn.1673-3770.0.2019.358

摘要/Abstract

摘要： 颈动脉损伤除可引起大出血、外伤性动静脉瘘、假性动脉瘤外,亦可直接影响大脑血液供应或回流。目前颈动脉损伤可分为颈动脉开放性损伤、颈动脉钝性损伤,两种损伤分别具有不同的诊断方法及处理方案。颈动脉损伤极为紧急,需尽快积极采取诊疗措施。就颈动脉损伤的诊断及其治疗方式的新进展作综述。

关键词: 颈动脉, 动静脉瘘, 栓塞, 支架

Abstract: Carotid artery injuries can cause bleeding, traumatic arteriovenous fistula, and pseudoaneurysm and can directly affect the blood supply or reflux to the brain. There are two types of carotid injury, penetrating carotid artery injury and blunt carotid artery injury, which are managed by different treatment options. Prompt treatment is imperative for carotid injuries. This paper summarizes the recent advances in the diagnosis and treatment of carotid artery injuries.

Key words: Carotid Arteries, Arteriovenous Fistula, Embolization, Stents

中图分类号:

R604

任昱, 肖旭平. 颈动脉损伤诊断与治疗进展[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 105-109.

REN Yu, XIAO Xuping. Advances in the diagnosis and treatment of carotid artery injuries[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 105-109.

参考文献

[1] 陆京伯, 刘爱华, 万恒, 等. 颅外段颈动脉损伤九例[J]. 中华创伤杂志, 2012,28(3):262-263. doi:10.3760/cma.j.issn.1001-8050. 2012.03.019. LU Jingbo, LIU Aihua, WAN Heng, et al. 9 cases of extracranial carotid artery injuries[J]. Chinese Journal of Trauma, 2012,28(3):262-263. doi:10.3760/cma.j.issn.1001-8050. 2012.03.019.
[2] Mittal VK, Paulson TJ, Colaiuta E, et al. Carotid artery injuries and their management[J]. J Cardiovasc Surg(Torino), 2000, 41(3): 423-431. doi:10.1016/S1053-0770(00)90140-X.
[3] Monson DO, Saletta JD, Freeark RJ. Carotid vertebral trauma[J]. J Trauma, 1969, 9(12): 987-999. doi:10.1097/00005373-196912000-00003.
[4] Kim JP, Park JJ, Won SJ, et al. Penetrating carotid artery injuries treated by an urgent endovascular stent technique: report of two cases[J]. Chonnam Med J, 2011, 47(2): 134-137. doi:10.4068/cmj. 2011.47.2.134.
[5] Brywczynski JJ, Barrett TW, Lyon JA, et al. Management of penetrating neck injury in the emergency department: a structured literature review[J]. Emerg Med J, 2008, 25(11): 711-715. doi:10.1136/emj. 2008.058792.
[6] Fonseca VJ, Martins Chaves RR, Baires Campos FE, et al. Applications of digital subtraction angiography in the management of penetrating injuries of the maxillofacial region: A case report[J]. Imaging Sci Dent, 2018, 48(4): 295-300. doi:10.5624/isd. 2018.48.4.295.
[7] Múnera F, Soto JA, Palacio D, et al. Diagnosis of arterial injuries caused by penetrating trauma to the neck: comparison of helical CT angiography and conventional angiography[J]. Radiology, 2000, 216(2): 356-362. doi:10.1148/radiology. 216.2.r00jl25356.
[8] Landwehr P, Schulte O, Voshage G. Ultrasound examination of carotid and vertebral arteries[J]. Eur Radiol, 2001, 11(9): 1521-1534. doi:10.1007/s003300100963.
[9] 符伟国, 王利新. 颈部血管损伤处理原则[J]. 中国实用外科杂志, 2007, 27(7): 510-513. doi:10.3321/j.issn:1005-2208. 2007.07.005.
[10] 孙占峰, 姜维良, 孙庆峰, 等. 颈动脉损伤的外科治疗(附16例报告)[J]. 中国实用外科杂志, 2007, 27(7): 534-536. doi:10.3321/j.issn:1005-2208. 2007.07.014. SUN Zhanfeng, JIANG Weiliang, SUN Qingfeng, et al. Surgical management of carotid artery injury: a report of 16 cases[J]. Chinese Journal of Practical Surgery, 2007, 27(7): 534-536. doi:10.3321/j.issn:1005-2208. 2007.07.014.
[11] Kuehne JP. Penetrating trauma of the internal carotid artery[J]. Arch Surg, 1996, 131(9): 942. doi:10.1001/archsurg.1996. 01430210040008.
[12] Aburahma AF, Stone PA, Hass SM, et al. Prospective randomized trial of routine versus selective shunting in carotid endarterectomy based on stump pressure[J]. J Vasc Surg, 2010, 51(5): 1133-1138. doi:10.1016/j.jvs. 2009.12.046.
[13] Hans SS, Jareunpoon O. Prospective evaluation of electroencephalography, carotid artery stump pressure, and neurologic changes during 314 consecutive carotid endarterectomies performed in awake patients[J]. J Vasc Surg, 2007, 45(3): 511-515. doi:10.1016/j.jvs. 2006.11.035.
[14] Reva VA, Pronchenko AA, Samokhvalov IM. Operative management of penetrating carotid artery injuries[J]. Eur J Vasc Endovasc Surg, 2011, 42(1): 16-20. doi:10.1016/j.ejvs. 2011.01.025.
[15] Jacobs JR, Arden RL, Marks SC, et al. Carotid artery reconstruction using superficial femoral arterial grafts[J]. Laryngoscope, 1994, 104(6 Pt 1): 689-693. doi:10.1288/00005537-199406000-00008.
[16] 李勇辉, 王劲松, 姚陈, 等. 颈动脉体瘤切除术中颈内动脉破裂的高危因素分析[J]. 中华医学杂志, 2017, 97(22): 1724-1728. doi:10.3760/cma.j.issn.0376-2491. 2017.22.010. LI Yonghui, WANG Jinsong, YAO Chen. Risk factors of rupture of internal carotid artery during surgical resection of carotid body tumor[J]. National Medical Journal of China, 2017, 97(22): 1724-1728. doi:10.3760/cma.j.issn.0376-2491. 2017.22.010.
[17] 陈杰, 周晓, 黄文孝, 等. 颈外动脉转位替代颈内动脉手术一例[J]. 中华耳鼻咽喉头颈外科杂志, 2008, 43(10): 794. doi:10.3321/j.issn:1673-0860. 2008.10.018. CHEN Jie, ZHOU Xiao, HUANG Wenxiao, et al. Anastomasis of the external carotid artery with the internal carotid artery for resection of extracranial internal carotid artery aneurysm: report of a case[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2008, 43(10): 794. doi:10.3321/j.issn:1673-0860. 2008.10.018.
[18] Toit DF, Coolen D, Lambrechts A, et al. The endovascular management of penetrating carotid artery injuries: long-term follow-up[J]. Eur J Vasc Endovascular Surg, 2009, 38(3): 267-272. doi:10.1016/j.ejvs. 2009.05.003.
[19] Schönholz C, Krajcer Z, Carlos Parodi J, et al. Stent-graft treatment of pseudoaneurysms and arteriovenous fistulae in the carotid artery[J]. Vascular, 2006, 14(3): 123-129. doi:10.2310/6670. 2006.00034.
[20] Li W, D'Ayala M, Hirshberg A, et al. Comparison of conservative and operative treatment for blunt carotid injuries: analysis of the National Trauma Data Bank[J]. J Vasc Surg, 2010, 51(3): 593-599. doi:10.1016/j.jvs. 2009.10.108.
[21] Biffl WL, Moore EE, Offner PJ, et al. Blunt carotid arterial injuries: implications of a new grading scale[J]. J Trauma, 1999, 47(5): 845-853. doi:10.1097/00005373-199911000-00004.
[22] Bromberg WJ, Collier BC, Diebel LN, et al. Blunt cerebrovascular injury practice management guidelines: the Eastern Association for the Surgery of Trauma[J]. J Trauma, 2010, 68(2): 471-477. doi:10.1097/TA. 0b013e3181cb43da.
[23] Harrigan MR, Weinberg JA, Peaks YS, et al. Management of blunt extracranial traumatic cerebrovascular injury: a multidisciplinary survey of current practice[J]. World J Emerg Surg, 2011, 6: 11. doi:10.1186/1749-7922-6-11.
[24] DiCocco JM, Emmett KP, Fabian TC, et al. Blunt cerebrovascular injury screening with 32-channel multidetector computed tomography: more slices still don't cut it[J]. Ann Surg, 2011, 253(3): 444-450. doi:10.1097/SLA.0b013e31820d946b.
[25] Malhotra AK, Camacho M, Ivatury RR, et al. Computed tomographic angiography for the diagnosis of blunt carotid/vertebral artery injury: a note of caution[J]. Ann Surg, 2007, 246(4): 632-642. doi:10.1097/SLA.0b013e3181568cab.
[26] Biffl WL, Egglin T, Benedetto B, et al. Sixteen-slice computed tomographic angiography is a reliable noninvasive screening test for clinically significant blunt cerebrovascular injuries[J]. J Trauma, 2006, 60(4): 745-751; discussion 751-752. doi:10.1097/01.ta.0000204034. 94034.c4.
[27] Utter GH, Hollingworth W, Hallam DK, et al. Sixteen-slice CT angiography in patients with suspected blunt carotid and vertebral artery injuries[J]. J Am Coll Surg, 2006, 203(6): 838-848. doi:10.1016/j.jamcollsurg. 2006.08.003.
[28] Chamoun RB, Mawad ME, Whitehead WE, et al. Extracranial traumatic carotid artery dissections in children: a review of current diagnosis and treatment options[J]. J Neurosurg Pediatr, 2008, 2(2): 101-108. doi:10.3171/PED/2008/2/8/101.
[29] Biffl WL, Ray CE, Moore EE, et al. Noninvasive diagnosis of blunt cerebrovascular injuries: a preliminary report[J]. J Trauma, 2002, 53(5): 850-856. doi:10.1097/00005373-200211000-00008.
[30] Mutze S, Rademacher G, Matthes G, et al. Blunt cerebrovascular injury in patients with blunt multiple trauma: diagnostic accuracy of duplex Doppler US and early CT angiography[J]. Radiology, 2005, 237(3): 884-892. doi:10.1148/radiol. 2373042189.
[31] Biffl WL, Cothren CC, Moore EE, et al. Western Trauma Association critical decisions in trauma: screening for and treatment of blunt cerebrovascular injuries[J]. J Trauma, 2009, 67(6): 1150-1153. doi:10.1097/TA.0b013e3181c1c1d6.
[32] Wahl WL, Brandt MM, Thompson BG, et al. Antiplatelet therapy: an alternative to heparin for blunt carotid injury[J]. J Trauma, 2002, 52(5): 896-901. doi:10.1097/00005373-200205000-00012.
[33] Burlew CC, Biffl WL. Blunt cerebrovascular trauma[J]. Curr Opin Crit Care, 2010, 16(6): 587-595. doi:10.1097/mcc.0b013e32833ee8b4.
[34] Pham MH, Rahme RJ, Arnaout O, et al. Endovascular stenting of extracranial carotid and vertebral artery dissections: a systematic review of the literature[J]. Neurosurgery, 2011, 68(4): 856-866; discussion 866. doi:10.1227/NEU.0b013e318209ce03.
[35] Cohen JE, Gomori JM, Itshayek E, et al. Single-center experience on endovascular reconstruction of traumatic internal carotid artery dissections[J]. J Trauma Acute Care Surg, 2012, 72(1): 216-221. doi:10.1097/TA.0b013e31823f630a.

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