口腔疾病防治 ›› 2017, Vol. 25 ›› Issue (12): 761–766.doi: 10.12016/j.issn.2096-1456.2017.12.003

• 专栏论著 • 上一篇    下一篇

头颈部严重木竹异物外伤的诊治经验

张大明1(), 周斌1, 张善义2, 杨朝晖1, 王建广1, 张彬1, 陈伟良1()   

  1. 1. 中山大学孙逸仙纪念医院口腔颌面外科,广东广州(510120)
    2. 中山大学孙逸仙纪念医院神经外科,广东广州(510120)
  • 收稿日期:2017-09-13 修回日期:2017-11-07 出版日期:2017-01-04 发布日期:2018-09-03
  • 作者简介:

    【作者简介】张大明,主治医师,博士,Email:lpg53372083@163.com

  • 基金资助:
    国家自然科学基金项目(81772888)

Management experience of severe wooden foreign bodies injuries in head and neck region

Daming ZHANG1(), Bin ZHOU1, Shanyi ZHANG2, Zhaohui YANG1, Jianguang1ZHANG Bin WANG1, Weiliang CHEN1()   

  1. 1. Department of Oral and Maxillofacial Surgery Sun Yat-sen Memorial Hospital Sun Yat-sen University Guangzhou 510120 China
    2. Department of Neurosurgery Sun Yat-sen Memorial Hospital Sun Yat-sen University Guangzhou 510120
  • Received:2017-09-13 Revised:2017-11-07 Online:2017-01-04 Published:2018-09-03

摘要:

目的 通过对10例严重的头颈部木竹异物外伤病例救治的回顾性分析,总结外科诊治经验。方法 选自2008年8月—2014年5月中山大学孙逸仙纪念医院口腔颌面外科收治的10例头颈部木竹异物外伤患者,对其年龄、致伤原因、部位、术前检查、术前评估、手术方式、手术时间、术中出血、异物长度、麻醉方式、术后处理等进行总结分析。结果 患者年龄2~76岁,平均40.9岁。跌落伤8例,工业伤2例。6例采用气管切开全麻,3例经鼻插管全麻,1例经口插管全麻。10例异物均被完全取出,长约4.0~17.5 cm(平均9.96 cm)。手术时间30~180 min。术中出血量3~200 mL(平均69 mL),无严重出血病例。随访11~38月, 均未出现严重术后并发症,仅1例出现开口型偏斜、2例颈部术后瘢痕不适。结论 术前详细检查、评估以及充分的术前准备十分必要;多学科多手段为安全取出严重的头颈外伤性木竹异物提供保障。

关键词: 木竹异物, 头颈部, 颌面外伤, 手术治疗

Abstract:

Objective To describe our experience with the surgical treatment of severe wooden foreign body (WFB) injuries in the head and neck region. Methods A case series review of WFB injuries in the head and neck region that were managed at Sun Yat-sen Memorial Hospital between 2008 and 2014 was performed retrospectively. The clinical findings and surgical details of ten cases were reviewed. Results The WFBs were integrally removed from all patients with the average age of 40.9 years. 8 cases dued to falling and 2 cases because of industrial injuries. All cases under-went general anesthesia (6 cases tracheal incision, 3 cases through nose intubation, 1 cases through oral intubation).The lengths of the WFBs ranged from 4.0 cm to 17.5 cm (average 9.96 cm). The procedures lasted 30 to 180 min. No se-vere bleeding was observed. Total blood loss ranged from approximately 3 to 200 mL (average 69 mL). The patients were followed for 11 to 38 months, and no postoperative complications, only 1 cases appeared open type deviation and 2 cases of scar discomfort after neck operation. Conclusion Surgical treatment of severe WFB injuries in the head and neck region is acceptably safe and effective. Endoscopic surgery can be used in patients with WFBs that are embedded in the maxilla.

Key words: Wooden foreign body, Head and neck, Trauma, Surgical treatment.

中图分类号: 

  • R781.42

表 1

10例临床病例资料"

病例 年龄(岁) 性别 致伤原因 木竹异物位置 异物长度(cm) 是否气切
1 2 跌落 硬腭至颅底 4.0
2 5 跌落 右舌至椎前 7.5
3 38 跌落 右颈至左咽旁 8.7
4 39 跌落 左颈至右颈 14.5
5 40 工业伤 左上颌窦至颅内 13+4.5
6 45 跌落 左颈至右咽旁 11.4
7 48 工业伤 右颊至右上颌窦 10.8
8 54 跌落 右颈至左咽旁 9.2
9 62 跌落 左颈至右咽旁 10.5
10 76 跌落 左颊至左颞下窝 5.5

图1

典型病例1"

图2

典型病例2"

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