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颈咽火器份常损及邻近的大血管、气管、食道、颈椎等重要器官组织,死亡率高。现报道我院遇到1例颈咽复合性火器伤。患者,男,45岁.农民。因被猎枪误击口咽部,7小时后经当地医院清创缝合。2天后发热,颈部肿痛、吞咽困难、右手麻木,1周后入我院。体检:张口受限,吐词不清,舌肺胀其前中1/3处见Y型缝合(长约4cm)。右颈部肿胀,肤红,压痛明显并有波动感,局部穿刺抽出脓液约20ml。右手痛麻减退,但握力仍差。翌日在局麻下行子弹取出术,分离时排放出臭味脓液约20ml,于颈深筋膜层动脉鞘后方取出一3×2cm大小形不整的金属弹片,冲洗后油纱条填充。术后患者突然口吐鲜血约300ml伴颈部渗血,入手术室打开创口,见颈3、4横突粉碎性骨折,横突间有3mm的椎动脉呈喷射状出血,用丝线结扎止血。探弹道与
Carotid pharynx firearm often damage and adjacent large blood vessels, trachea, esophagus, cervical and other vital organs and tissues, high mortality. It is reported that our hospital encountered 1 case of jacketed complex firearm injuries. Patient, male, 45 years old. Farmer. Shotguns were mistaken for the pharynx, 7 hours after the local hospital debridement and suture. 2 days after fever, neck swelling and pain, swallowing difficulties, right numbness, into the hospital after 1 week. Physical examination: restricted mouth, spit word is unclear, tongue swelling in front of 1/3 to see Y-type suture (about 4cm). Right neck swelling, redness, tenderness and a clear sense of volatility, pus out of the local puncture about 20ml. Right hand pain decreased, but grip is still poor. The next day under local anesthetic bullet removed surgery, separation of stinky pus discharge of about 20ml, in the deep fascia layer after the arterial sheath removed a 3 × 2cm irregularly shaped metal shrapnel, washed yarn gauze filled. After the patient suddenly vomit blood about 300ml with bleeding in the neck, into the operating room to open the wound, see the neck 3, 4 transverse comminuted fracture, 3mm transverse process between the vertebral artery was jet-like bleeding, with silk ligation to stop bleeding. Explore the trajectory and