双侧颈内动脉重度狭窄不使用转流管行颈动脉内膜剥脱术  

Carotid endarterectomy in patients with bilateral internal carotid artery severe stenosis without intraoperative shunting

作　　者：厉建林[1] 王兵[1] 王越[2] 丁语[1] 崔文军[1] 王霖[1] 

机构地区：[1]郑州大学第五附属医院血管外科,450001 [2]郑州大学临床医学系,450052

出　　处：《实用医学杂志》2012年第21期3601-3603,共3页The Journal of Practical Medicine

摘　　要：目的:颈动脉内膜剥脱术(carotid endarterectomy,CEA)在治疗双侧颈内动脉(internal carotid artery,ICA)重度狭窄患者时,术中不使用转流管及脑电图(electroencephalography,EEG)监测的安全性评价。方法:回顾性分析2010年1月至2012年3月郑州大学第五附属医院收治的31例双侧ICA重度狭窄并行CEA患者的临床资料,查看患者术后医疗记录有无新发神经病学损害,并随访4～6个月评估神经功能状态。结果:31例患者成功行38例次CEA,7例先后行双侧CEA,所有患者术中均未采用血管内转流及EEG或经颅多普勒超声监测。术后1例患者出现过度脑灌注综合征,经积极对症治疗后好转,其余患者未出现新发神经病学损伤。所有病例在4～6个月随访中均未出现新的神经病学症状或体征。结论:双侧颈动脉重度狭窄患者行CEA,术中不采用血管内转流及EEG监测亦是安全有效的。Objective Assess the safiy without shunting or electroencephalography （EEG） monitoring during carotid endarterectomy （CEA） for bilateral high-grade stenosis patients. Methods Retrospectively analyze the data of 31 patients met criteria of bilateral internal carotid artery high-grade stenosis underwent CEA in the Fifth Affiliated Hospital of Zhengzhou University from January 2010 to March 2012. The medical records were screened for new neurological changes postoperatively. The patients were also seen 4 ~ 6 months postoperatively to assess their neurological status. Results The total of 38 endarterectomies were successfully completed without shunting or EEG or transcranial Doppleruhrasound monitoring. Of those patients, 7 underwent bilateral CEA. Postoperatively, one patient presented with hyperperfusion syndrome that was improved after positive treatment, no new neurological changes of the other patients were noted. None of the 31 patients developed any new neurological symptoms or signs at 4 - 6 months follow-up. Conclusion CEA is secure for bilateral high-grade stenosis patients without intravascular shunting or EEG monitoring.

关 键 词：颈动脉内膜剥脱术 双侧颈动脉重度狭窄 血管内转流 脑电图监测 

分 类 号：R654.3[医药卫生—外科学]