经颅多普勒在颈动脉内膜切除术的应用价值  

lhe Value of Transcranial Doppler in Carotid Endarterectomy

作　　者：高凤玲[1] 徐忠宝[1] 李继梅[1] 陈学明[2] 张春玲[1] 史佳云[1] 

机构地区：[1]首都医科大学附属北京友谊医院神经内科,北京100050 [2]首都医科大学附属北京友谊医院胸外科,北京100050

出　　处：《国际脑血管病杂志》2007年第7期509-513,共5页International Journal of Cerebrovascular Diseases

摘　　要：目的：探讨经颅多普勒（K1D）在颈动脉内膜切除术（CEA）中的应用价值。方法：回顾性总结首都医科大学附属北京友谊医院2000-2007年2月48例CEA病例（54条血管）。全部患者均先由TCD检出，经CT血管造影（CTA）或数字减影血管造影（DSA）证实后行CEA。CEA部分患者行术中K1D监测。48例患者术后定期TCD和临床随访。结果：48例患者中TCD检出59条颈内动脉（ICA）重度狭窄或闭塞，其中9条完全闭塞，11例为双侧ICA重度狭窄或闭塞。48例患者中，42例行单侧CEA，6例行双侧CEA。11例CEA病例行术中TCD监测。5例术中出现并发症（过度灌注、低灌注、栓子、血管再通不良）。围手术期死亡1例（2．08％）。术后平均随访42．2个月，检出1条动脉重度再狭窄，2条动脉中度再狭窄，再狭窄发生率为6．4％。结论：TCD检出ICA重度狭窄（≥70％）的特异性和准确性均很高，可筛选出患者并经DSA或CTA证实后行CEA。术中监测可提高手术安全性，术后随访可无创性观察CEA动脉和颅内外动脉的动态变化。关键词经颅多普勒；颈动脉内膜切除术；Objective： To explore the value of transcranial Doppler （TCD） in carotid endarterectomy （CEA）. Methods： The data of 48 patients （54 arteries） whose CEA were performed in Beijing Friendship Hospital Affiliated to Capital University of Medical Sciences from 2000 to February 2007 were analyzed retrospectively. All the patients were detected first by TDD, and then CEA was performed after being confirmed by CT angiography （CTA） or digital subtraction angiography （DSA）. lntraoperative TCD monitoring during CEA were performed in part of the patients, The regular postoperative TCD and clinical follow-up were performed in 48 patients. Results： Fifty-nine internal carotid arteries （ICAs） with severe stenosis or occlusion in 48 patients were detected by TCD, among them, 9 ICAs were occluded completely, and 11 patients had bilateral carotid arteries severe stenosis or occlusion. Of the 48 patients, 42 performed unilateral CEA, 6 performed bilateral CEA. Eleven CEA patients were monitored intraoperatively by TCD. Five patients developed complications （hyperperfusion, hypoperfusion, embolus, and poor recanalization） during the operation. There was 1 perioperative death （2.08%）. The mean follow-up period was 42.2 months after the operation. One severe restenosis and two moderate restenoses were detected, and the incidence of restenosis was 6.4%. Conclusions： TCD has high sensitivity and specificity in detecting severe stenosis （i〉70%）. Patients can be screened, and CEA can be performed after being confirmed by DSA and TCD. Intraoperative monitoring may increase the safety of surgery. Postoperative follow-up may non-invasively observe the CEA and dynamic changes of intra- and extracranial arteries.

关 键 词：经颅多普勒 颈动脉内膜切除术 颈动脉狭窄 

分 类 号：R651[医药卫生—外科学]