置腔内转流管和颈动脉补片行颈动脉内膜剥脱术(附45例报告)  

Carotid endarterectomy with routine shunting and patch:a report of 45 cases.

作　　者：余波[1] 王铁平[1] 史伟浩[1] 何勍[1] 倪泉兴[1] 

机构地区：[1]复旦大学附属华山医院外科,上海200040

出　　处：《中国实用外科杂志》2006年第10期769-771,共3页Chinese Journal of Practical Surgery

摘　　要：目的探讨颈动脉内膜切除剥脱术（CEA）的手术方法及技巧，以降低围手术期脑卒中发生率及术后再狭窄发生率。方法2001年3月至2005年3月复旦大学附属华山医院血管外科行CEA45例，其中颈动脉硬化单侧狭窄36例、双侧9例。短暂性脑缺血（TIA）32例，缺血性脑卒中7例，无神经系统症状者4例。术前常规行多普勒彩超检查，9例行DSA检查，38例行CTA检查。颈内动脉起始段平均狭窄为（69±12）％。所有病人均在全麻下行CEA，术中常规置颈动脉转流管及用牛心包补片作颈动脉成形术。手术时间平均110min。脑缺血时间平均2min45s。结果围手术期及术后30d均无死亡及脑卒中发生，2例分别于术后6h及10h出现TIA。术后随访6—42个月，均未发生脑卒中。32例TIA病人，28例症状消失，4例症状改善。1例8个月后颈动脉轻度狭窄（〈30％），其余病人颈动脉均无再狭窄。结论颈动脉内膜剥脱术中，常规运用颈动脉转流管及常规采用牛心包补片做动脉成形术可使手术更安全有效及减少术后再狭窄的发生。Objective To study the methods and skill of carotid endarterectomy （CEA） for reducing the stroke incidence perioperatively and restenosis of carotid artery after operation. Methods Forty-five patients with carotid stenosis, 40 males and 5 females,with a mean age of 62 ±6yr,were underwent CEA in Huashan Hospital from Mar. 2001 to Mar. 2005. Among them ,32 patients were performed for TIAs,7 for stroke and 4 for asymptomatic diseases, Duplex scanning, DSA （8 patients） and CTA （38 patients） were done before operation, The average percentage of carotid stenosis was 69% ± 12% with ECST criteria, The CEA were performed under general anaesthesia with routine intraluminal shunt and carotid patch, The mean time of CEA was I hour and 50 minutes and the mean clamping time was 2 min and 45 sec, Restilts There was no mortality or stroke perioperative and 30 days postoperatively. Two patients were suffered from TIAs in 6 and 10 hours postoperatively. The TIAs symptoms disappeared in 28 patients and relieved in 2 patients, All patients were followed up for a mean interval of 31 ± 20 months（ range ：6 -42months） and no neurological events occurred during follow-up. One recurrent stenosis （ 〈 30% ） was detected on follow-up Duplex scan. Conclusion Carotid eodarterectomy using routine intraluminal shunt and carotid patch is a safe and effective procedure with low mortality and stroke rates and reducing the restenosis of carotid artery.

关 键 词：颈动脉硬化狭窄 颈动脉内膜剥脱术 缺血性脑卒中 

分 类 号：R6[医药卫生—外科学]