颈动脉内膜剥脱术在颈动脉硬化性狭窄患者中的疗效  

Efficacies of carotid endarterectomy in the treatment of atherosclerotic carotid artery stenosis

作　　者：谷涌泉[1] 郭连瑞[1] 齐立行[1] 李学锋[1] 郭建明[1] 俞恒锡[1] 崔世军[1] 吴英锋[1] 佟铸[1] 武欣[1] 张建[1] 汪忠镐[1] 华扬[2] 

机构地区：[1]首都医科大学宣武医院血管外科首都医科大学血管外科研究所,北京100053 [2]首都医科大学宣武医院血管超声科,北京100053

出　　处：《中华医学杂志》2011年第45期3197-3200,共4页National Medical Journal of China

摘　　要：目的 探讨动脉内膜剥脱术治疗颈动脉狭窄的可行性和疗效.方法 回顾性分析首都医科大学寅武医院血管外科白2002年1月至2010年12月针对颈动脉硬化性狭窄患者施行的126例颈动脉内膜剥脱术（CEA）.其中男92例,女34例,平均年龄65.5岁（48～75岁）；脑梗死后遗症25例,有脑缺血症状69例,无症状32例；术中62例行经颅多普勒超声（TCD）监测；颈动脉阻断后脑血流速度下降＞50％的5例患者采用了动脉转流管；64例患者未行术中TCD监测,均采用了动脉转流管；术中22例分别采用了自体或人工血管补片成形,2例同时行颈-锁骨下动脉人工血管旁路术.术中术后采用控制血压、颈动脉压迫等方法防止颅内过度灌注.结果 所有手术均获成功,无围手术期死亡.全部有症状患者及部分脑梗死后遗症患者均有不同程度改善,术后伸舌偏斜10例,2周内恢复8例.随访118例,平均随访时间46.5个月（6～96个月）,2例舌偏有改善；2例颈动脉重度狭窄,行支架成形术；4例颈动脉中度狭窄,继续随访；死亡7例,包括2例脑梗死.结论 CEA治疗颈动脉狭窄成功率高,疗效可靠.术中TCD监测利于防止脑缺血及颅内过度灌注；术中应根据患者具体情况采用动脉转流管和动脉补片成形.Objective To explore the feasibility and efficacy of carotid endarterectomy（CEA）in the treatment of atherosclerotic carotid artery stenosis（ACAS）.Methods From January 2002 to December 2010,126 ACAS patients undergoing carotid endarterectomy at our hospital were retrospectively analyzed.There were 92 males and 34 females with an average age of 65.5 years old（range：48-75）.Among them,25 had sequelae of cerebral infarction,69 symptomatic cerebral ischemia and 32 asymptomatic.Sixty-two patients were monitored intra-operatively with transcranial Doppler（TCD）.Among them,5 patients underwent arterial shunt due to a reduced b,ction of blood flow in middle cerebral artery for over 50%.The other 64 patients without TCD monitoring underwent intra-operative arterial shunt.And 22 patients underwent patch angioplasty with autologous or prosthetic vascular patch.Intracranial hyperperfusion was prevented by a compression of common carotid artery or control was successful without perioperative mortality.All patients with cerebral ischemic symptoms and some patients with cerebral infarction sequelae had much post-operative improvement.Deviated tongue protrusion occurred in 10 patients and 8 of them recovered at Week 2 postoperation.And 118 patients were followed up for a mean period of 46.5 months（range：6-96）.Twopatients with deviated tongue protrusion had slight improvements; 2 patients with severe carotid artery stenosis underwent stent angioplasty; 4 patients with moderate carotid artery steno,sis received conservative treatment; among 7 deceased patients,two died of cerebral infarction.Conclusion CEA is effective in the treatment of carotid artery stenosis with a high success rate.TCD monitoring during CEA is valuable for preventing cerebral ischemia and intracranial hyperperfusion.Arterial shunt and arterial patch angioplasty should be considered according to certain conditions during CEA.

关 键 词：颈动脉狭窄 颈动脉内膜剥脱术 超声监测 颈动脉转流管 颅内高灌注 

分 类 号：R651[医药卫生—外科学]