血管重建术治疗Metz Ⅲ级颈内动脉扭曲  

Reconstructive vascular operation for kinking of internal carotid artery

作　　者：王继跃 郝继恒 张士刚 张利勇 刘卫东 林凯 

机构地区：[1]山东省聊城市脑科医院神经外科,252000

出　　处：《中华外科杂志》2011年第2期109-112,共4页Chinese Journal of Surgery

基　　金：国家＂十一五＂科技支撑计划资助项目（2006BAI01A13）

摘　　要：目的 探讨血管重建术治疗Metz Ⅲ级颈内动脉扭曲的可能性及总结治疗经验.方法 2008年7月至2009年6月应用血管重建术治疗症状性颈内动脉扭曲患者5例,其中男性2例,女性3例;年龄53～68岁,平均62岁.手术在患者颈内动脉起始部环形切断,游离并拉直颈内动脉,根据扭曲的情况剪除多余的血管;2例动脉粥样硬化明显者首先行外翻式内膜切除术,然后吻合颈内及颈总动脉.结果 5例患者术后顺利恢复,脑缺血症状改善明显.除1例出现轻度高灌注综合征外无其他明显并发症,复查颈动脉CT血管造影,示扭曲血管已拉直,血管通畅良好.随访5～16个月,未再出现短暂脑缺血发作及脑梗死,复查颈动脉血管超声未发现再狭窄者.结论 血管重建术是治疗Metz Ⅲ级颈内动脉扭曲的有效方法,但该手术仍有一定的风险,术前应进行全面的评估,严格控制手术适应证.Objective To evaluate and summarize the possibility and experience of reconstructive vascular operation for kinking of internal carotid artery. Methods Reconstructive vascular operation was performed on 5 patients with symptomatic kinking of internal carotid artery between July 2008 and June 2009. There were 2 male and 3 female patients,age ranged from 53 to 68 years（ mean 62 years）. Cutting the internal carotid artery at the bifurcation, mobilizing and stretching the internal carotid artery, then anastomosing the internal and common carotid artery. Two of them underwent endarteriectomy simultaneously. Results For the 5 patients, postoperative recovery went smoothly and symptoms were well improved. Except that mild high perfusion syndrome happened in 1 patient, no other obvious complications.Kinking of internal carotid artery had been stretched in the postoperative CT angiography. In the 5-16-month follow-up, no tranient ichemic attack or cerebral infarction happened, and no restenosis appeared.Conclusions Reconstructive vascular operation is an effective surgical approach to kinking and coiling of the internal carotid artery. For some risk exists, all-round evaluation should be performed before operation,and operative indication should be strictly controlled.

关 键 词：颈动脉疾病 脑血管重建术 扭曲 

分 类 号：R654.3[医药卫生—外科学]