显微颈动脉内膜切除术治疗颈动脉狭窄和闭塞  

Clinical analysis of microsurgical carotid endarterectomy for carotid stenosis and occlusion

作　　者：王涛[1] 武文元[1] 王凯[1] 刘二兵[1] 闫海成[1] 高乃康[1] 王飞[1] 刘海波[1] 武强[1] 戴志刚[1] 

机构地区：[1]内蒙古医学院附属医院神经外科,呼和浩特010050

出　　处：《中华外科杂志》2009年第6期407-410,共4页Chinese Journal of Surgery

基　　金：国家“十一五”科技支撑计划项目资助（2006BA101A13）;内蒙古自治区卫生厅学科建设重点资助科研项目资助（2005077）

摘　　要：目的探讨颈动脉内膜切除术治疗颈动脉粥样硬化性狭窄和闭塞的疗效。方法2005年8月至2008年11月16例患者均经彩色超声、磁共振血管成像（MRA）、CTA、数字减影血管造影证实为中重度颈动脉狭窄，14例狭窄率为60％～99％，2例完全闭塞；12例行标准颈动脉内膜切除术，4例行外翻式颈动脉内膜切除术；2例术中放置转流管；1例术中行补片成形术。所有手术均借助显微镜完成。结果围手术期及术后随访无卒中、短暂性脑缺血及死亡病例。术后均经彩色超声、MRA检查证实颈内动脉血流通畅，术后原症状改善或消失。1例并发消化道出血，1例围手术期有声嘶、呛水，对症治疗后症状消失，余均无并发症。结论颈动脉内膜切除术是治疗颈动脉狭窄的有效方法，采用不同术式及技术，对不同颈动脉病变可以达到最佳治疗效果；显微手术有助于高位分叉颈动脉的显露，能有效避免颅神经损伤及其他并发症。Objective To evaluate the clinical effects of carotid endarterectomy for carotid stenosis and occlusion. Methods From August 2005 to November 2008 moderate and severe carotid stenosis or occlusion were found in 16 patients by Doppler ultrasonography （ DUS）, MRA, CTA, DSA. The stenosis degree ranged from 60% to 99% in 14 patients and complete occlusion in 2 patients. Twelve patients underwent standard carotid endarterectomy （sCEA） in whom 2 patients were placed carotid shunt and 1 patient underwent carotid patch angioplasty. Four patients underwent eversion carotid endarterectomy （eCEA）. All operations were performed by microscope. Results There was no stroke, transient ischemic attack and mortality perioperatively and during follow-up from 1 month to 3 years. The ICA flow detected by follow-up duplex scan and MRA was unobstructed. The primary cerebral ischemic symptoms were obviously improved or disappeared after operation. The postoperative complications included one case of upper gastrointestinal hemorrhage and one case of hoarseness and bucking, which disappeared after medical treatment. Conclusions CEA is an effective way for treating carotid stenosis. Different operative methods and techniques deal with different carotid lesions to achieve better effect. Microsurgical technique is useful for exposure of high ICA bifurcation and avoid effectively cranial nerve injury and other complications.

关 键 词：颈动脉狭窄 动脉粥样硬化 颈动脉内膜切除术 转流 显微手术 

分 类 号：R686[医药卫生—骨科学]