常规不转流行颈动脉内膜剥脱术治疗颈动脉狭窄68例的临床疗效分析

doi:10.19854/j.cnki.1008-2425.2022.05.0007

摘要/Abstract

摘要： 目的探讨常规不转流行颈动脉内膜剥脱术(carotid endertarectomy,CEA)治疗颈动脉狭窄患者的临床疗效。方法回顾性分析2019年01月至2020年09月在徐州医科大学附属医院神经外科脑血管外科接受颈动脉内膜剥脱术治疗的68例颈动脉狭窄患者的临床资料,其中对侧颈动脉轻中度狭窄59例(A组),对侧颈动脉重度狭窄8例(B组),对侧颈内动脉闭塞1例(C组)。所有患者均行标准纵切式颈动脉内膜剥脱术且术中未使用转流管进行颈动脉转流。随访并统计术后30天内所有患者术侧新发脑卒中、心肌梗死、过度灌注等并发症和病死率,评估常规不转流行颈动脉内膜剥脱术的安全性。结果 68例患者均成功实施CEA,术中均未进行转流,平均手术时间120±20 min,平均阻断时间25±5 min,术后所有患者复查颈部CTA见狭窄均解除,30天内均无术侧新发脑梗、心肌梗塞及死亡病例,8例患者出现稍剧烈头痛(A组5例,B组3例,C组0例),予以对症处理后均好转。所有手术结果均符合美国心脏协会(American Heart Association,AHA)提出的手术标准^[1]。结论常规不转流行颈动脉内膜剥脱术是安全有效的,但术前需严格评估Willis环代偿情况、心脏冠脉功能,术中需行经颅多普勒超声(Transcranial Doppler,TCD)、脑氧饱和度等监测,必要时需提高血压,并尽量缩短阻断时间。

关键词: 颈动脉狭窄, 颈动脉内膜剥脱术, 颈动脉转流, 脑卒中, 术后并发症

Abstract: Objective To investigate the clinical efficacy of Conventional Carotid Endarterectomy (CEA) for patients with Carotid artery stenosis disease.Methods The clinical data of 68 patients with Carotid endarterectomy treated in neurosurgery department of Cerebrovascular Surgery,Affiliated Hospital of Xuzhou Medical University,from January 2019 to September 2020,were analyzed retrospectively,there were 59 cases of mild and moderate stenosis in contralateral carotid artery (Group A),8 cases of severe stenosis in contralateral carotid artery (Group B) and 1 case of contralateral internal carotid artery occlusion (Group C).Standard Longitudinal Carotid endarterectomy was performed in all patients and carotid bypass was not performed during the operation.All patients were followed up for 30 days after operation,and no patientshadnew stroke,myocardial infarction,hyperperfusion and other complications and mortality,to evaluate the safety of routine carotid endarterectomy without shunt.Results CEA was successfully performed in all 68 patients.The mean time of operation was 120 ± 20 minutes,the mean time of block was 25 ± 5 minutes.All patients were relieved of neck CTA Stenosis,and no new cerebral infarction or myocardial infarction occurred in 30 days,8 patients presented with Severe Headache (5in Group A,3 in Group B and 0 in Group C).No deaths.All surgical results met the AHA criteria ^[1].Conclusion Routine Carotid endarterectomy is safe and effective,but the compensation of Willis Circle and the function of coronary artery should be evaluated strictly before operation,TCD and cerebral oxygen saturation should be monitored during operation,and blood pressure should be raised if necessary,and try to minimize the blocking time.

Key words: Carotid artery stenosis, Carotid Endarterectomy, Shunt, Stroke, Postoperative complications

中图分类号:

R543.4

王强, 谢满意, 王岩, 聂耳, 赵赛赛, 李中林. 常规不转流行颈动脉内膜剥脱术治疗颈动脉狭窄68例的临床疗效分析[J]. 立体定向和功能性神经外科杂志, 2022, 35(5): 290-294.

Wang Qiang, Xie Manyi, Wang Yan, et al. Clinical efficacy analysis of conventionalcarotid endarterectomy without shunt in 68 casesof carotid stenosis[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2022, 35(5): 290-294.

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