颈动脉内膜切除术中转流管的应用及侧支代偿对其的影响  

Application of shunting during carotid endarterectomy and impact of collateral circulation on it

作　　者：郭锋[1,2] 凌锋[1] 张文彬[1,3] 宋刚[1] 华扬[4] 蔡兵[5] 谌燕飞[1] 焦力群[1] 

机构地区：[1]首都医科大学宣武医院神经外科,北京100053 [2]山东省临沂市人民医院神经外科,276003 [3]山东省肥城市人民医院 [4]首都医科大学宣武医院血管超声科,北京100053 [5]首都医科大学宣武医院麻醉科,北京100053

出　　处：《中国脑血管病杂志》2012年第5期233-237,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：“十二五”国家科技支撑计划(2011BAI08B04);北京市科技新星计划(2007A078)

摘　　要：目的探讨颈动脉内膜切除术(CEA)中转流管应用的优缺点,以及对侧颈动脉闭塞及前、后交通动脉开放对其的影响。方法回顾性分析2000年1月—2011年9月共308例CEA病例,根据是否应用转流管分为两组,转流组63例,未转流组245例。比较两组术中微栓子数量,术后卒中及死亡率。比较两组中对侧颈动脉狭窄程度以及前、后交通动脉开放的比例,分析其对转流管应用的影响。结果①转流组患者微栓子的中位数为25个,未转流组为10个,两组差异有统计学意义(P<0.05)。②术后1个月内缺血事件的发生率,转流组患者卒中1例(1.6%),无一例死亡;未转流患者卒中6例(2.4%),死亡4例(1.6%)。两组的卒中及病死率差异均无统计学意义(P>0.05)。③术前对侧颈动脉狭窄的程度,转流组患者中有8例闭塞,8例重度狭窄,47例轻中度狭窄或无狭窄。未转流组患者中,分别为9、36、200例。两组闭塞率(12.7%比3.7%)比较,差异有统计学意义(P<0.05)。术前前交通动脉及后交通动脉均未开放的患者,转流组有35例(55.6%),未转流组有81例(33.1%),两组比较差异有统计学意义(P<0.01)。结论 CEA中使用转流管虽增加微栓子的数量,但并未增加围手术期卒中及死亡率。术前伴有对侧颈动脉闭塞的患者或前、后交通动脉均未开放的患者,使用转流管的比例明显高于其他患者。Objective To investigate the advantages and disadvantages of shunting during carotid endarterectomy as well as the impact of contralateral carotid occlusion and the patent of anterior and posterior communicating arteries on it.Methods A total of 308 patients who performed carotid endarterectomy from January 2000 to September 2011 were analyzed retrospectively.They were divided into shunting（n=63） and non-shunting（n=245） groups.The intraoperative microemboli,postoperative stroke and mortality in both groups were compared.The degree of contralateral carotid stenosis,the opening ratios of anterior and posterior communicating arteries were compared in both groups.Its impact on shunting was analyzed.Results ①The median microemboli count was 25 in the shunting group and it was 10 in the non-shunting group.There was significant difference between the 2 groups（P0.05）.②The incidence of ischemic events within one month after surgery： 1 patient（1.6%） had stroke and 0 died in the shunting group;6 patients（2.4%） had stroke and 4（1.6%） died in the non-shunting group.There were no significant differences for stroke and mortality between both groups（P0.05）.③The degree of contralateral carotid artery stenosis before surgery： 8 patients had occlusion,8 had severe stenosis,47 had mild to moderate stenosis or without stenosis in the shunting group;9 patients had occlusion,36 had severe stenosis,and 200 had mild to moderate stenosis or without stenosis in the non-shunting group.The rate of occlusion was significant differences between the 2 groups（P0.05）.Both preoperative anterior and posterior communicating arteries of 35 patients（55.6%） did not open in the shunting group and 81（33.1%） did not open in the non-shunting group.There was significant difference between the 2 groups（P0.05）.Conclusion Although using shunting may increase the number of microemboli in carotid endarterectomy,but not increase the incidence of perioperative stroke and mortality.The patients with preoperative

关 键 词：颈动脉疾病 颈动脉内膜切除术 转流管 

分 类 号：R651[医药卫生—外科学]