背景:气步枪损伤可导致严重的血管损伤。这种气步枪伤害导致穿透颈总动脉的颈部创伤。关于放射性调查的必要性存在争议,最合适的研究模式,以及手术探查与保守方法的必要性。本病例报告旨在举例说明管理颈动脉穿透性损伤(PCI)的成功方法,同时阐明管理决策背后的基本原理。
方法:一名18岁的白种人在颈部右侧受到气步枪伤害后到达医院,伴有活动性出血和中度血肿,使气管移位。他的血液动力学稳定,格拉斯哥昏迷评分(GCS)为15,没有杂音的证据。计算机断层扫描血管造影(CTA)显示右颈总动脉(CCA)动脉损伤并伴有创伤后假性动脉瘤。颗粒轨迹穿过右上甲状腺。双工超声扫描(USS)确认了右CCA处的两个动脉腮红区域。管理涉及全身麻醉(G.A.)下的颈部探查,修复右CCA,子弹拔除,和伤口冲洗。他接受了抗生素治疗十天,并接受了单一抗血小板治疗三个月,术后两天出院,无并发症。他被随访了八个月,没有任何创伤后遗症的证据。
结论:颈动脉穿透性损伤是一个严重的问题。小尺寸的颗粒具有栓塞的风险。因此,颈部探查仍是PCI治疗的金标准.适当的手术计划至关重要,可以在血流动力学稳定的患者中使用放射学诊断方式进行优化。CTA是非侵入性的,Swift,和动脉造影的适当替代方法,提供关于血管和空气消化损伤和子弹弹道的有价值的诊断信息。这使得适当的准备能够在这种关键情况下取得出色的结果。
BACKGROUND: Air rifle injuries can cause significant vascular injuries. This air rifle injury has resulted in a penetrating neck trauma traversing the common carotid artery. There is debate around the need for radiological investigation, the most appropriate investigational modality, and the need for surgical exploration versus a conservative approach. This
case report aims to exemplify a successful approach to managing Penetrating Carotid Injuries (PCI) while shedding light on the rationale behind the management decisions.
METHODS: An 18-year-old Caucasian man arrived at the hospital following an air rifle injury to the right side of the neck, with active bleeding and a moderate haematoma displacing the trachea. He was haemodynamically stable, with a Glasgow Coma Scale (GCS) of 15 and no evidence of bruit. Computed Tomography Angiography (CTA) showed Right common carotid (CCA) artery injury with associated post-traumatic pseudoaneurysm. The pellet trajectory traverses the right superior thyroid gland. A duplex ultrasound scan (USS) confirmed two areas of arterial blush at the right CCA. Management involved neck exploration under General Anaesthesia (G.A.), repair of right CCA, bullet extraction, and wound washout. He received antibiotics for ten days and a single agent of antiplatelets for three months and was discharged two days postoperatively with no complications. He was followed up for eight months with no evidence of any trauma sequelae.
CONCLUSIONS: Penetrating carotid artery injuries are a serious concern. The small-sized pellets carry the risk of embolization. Therefore, neck exploration remains the gold standard treatment for PCI. Appropriate operative planning is crucial and can be optimised using radiological diagnostic modalities in haemodynamically stable patients. CTA is a non-invasive, swift, and adequate alternative to arteriography, providing valuable diagnostic information on vascular and aerodigestive injuries and bullet trajectory. This enables appropriate preparedness to achieve excellent outcomes in such critical cases.