颈动脉内膜切除术治疗颈动脉狭窄有效性及安全性的多中心研究  

Efficacy and safety of carotid endarterectomy in the treatment of carotid artery stenosis: a multicenter study

作　　者：陈东[1] 焦力群[2] 王继跃[3] 万晓楠[1] 石军伟[1] 张利勇[3] 尹国阳[2] 凌锋[2] 

机构地区：[1]大连市中心医院神经外科,116033 [2]首都医科大学宣武医院神经外科 [3]聊城市人民医院脑科医院神经外科

出　　处：《中国脑血管病杂志》2013年第9期452-457,共6页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的分析采用颈动脉内膜切除术(CEA)治疗颈动脉狭窄的有效性及安全性,评估影响术后≤30 d卒中和死亡的危险因素。方法回顾性分析大连市中心医院、首都医科大学宣武医院和聊城市人民医院脑科医院于2001—2011年连续采用CEA治疗的颈动脉狭窄患者的临床资料,共494例(其中15例分期行双侧手术,每例按2例单独病例进行计算,共计509例)。观察手术的安全性和有效性。采用单因素及多因素Logistic回归分析,评估影响患者术后≤30 d不良事件的相关因素。结果①509例中,439例单纯颈动脉狭窄的患者,血管全部通畅;70例颈动脉完全闭塞或狭窄率为95%～99%的患者中,7例未能再通。手术成功率为98.6%。②术后≤30 d,发生主要不良终点事件有20例(3.9%),其中死亡6例(1.2%),卒中14例(2.8%);次要不良事件120例(23.6%)。③503例生存患者术后3个月全部获随访,对其中494例(98.2%)患者进行了≥6个月的随访。在随访期间,5例发生新发卒中,其中1例为致死性卒中;28例(5.6%)发生再狭窄,闭塞6例(1.2%)。④单因素分析显示,术前改良Rankin评分(mRS)≥3分者,术后≤30 d卒中和死亡发生率明显高于<3分者(17.4%比2.6%,P<0.01)。多因素Logistic回归分析显示,吸烟(OR=2.667,95%CI:1.048～6.791,P=0.040)和mRS评分≥3分(OR=8.690,95%CI:3.279～23.031,P=0.000)是术后≤30 d主要不良终点事件的独立危险因素。术者学习曲线对术后≤30 d主要终点事件有影响。结论 CEA治疗颈动脉狭窄安全、有效。但对于吸烟和术前神经功能缺损严重的患者,手术的风险会相应增加。Objective To retrospectively analyze the efficacy and safety of carotid endarterectomy （CEA） in the treatment of carotid artery stenosis in three domestic hospitals and to evaluate the risk factors affecting stroke and death within ≤30 days after procedure. Methods The clinical data of 494 patients with carotid artery stenosis （ 15 of them underwent bilateral operation, each patient was calculated as two separate cases, there were a total of 509 cases. ） treated with CEA at Beijing Xuanwu Hospital of Capital Medical University, Liaocheng Brain Hospital, and Dalian Municipal Central Hospital from 2001 to 2011 were summarized retrospectively. The safety and efficacy of the procedure were observed. Univariate and muhivariate logistic regression analysis was used to assess the related factors that impacted the adverse e- vents in patients within≤ 30 days after procedure. Results ①In the 509 patients, 439 with simple ste- nosis had vascular patency ; 70 patients had been completed occlusion or near-total occlusion, seven of themfailed recanalization. The success rate of surgery was 98.6%. ②Within 30 days after procedure,20 cases （3.9%） had adverse outcome , including 6 died （ 1.2% ） and 14 had stroke （2.8%）. The secondary adverse outcome occurred in 120 cases （23.6%）. ③All the 503 survival patients were followed up at 3 months after procedure, among them 494 （98.2%） were followed up for ≥ 6 months. During the follow-up period, 5 had new attack of stroke, one of them was died; 28 （5.6%） had restenosis and 6 （ 1.2% ） had occlusion. ④Univariate analysis showed that the incidences of stroke and death within 30 days after proce- dure in patients with preoperative modified Rankin scale （mRS） ≥ 3 were significantly higher than those 〈 3 （ 17.4% vs. 2.6% ; P 〈 0.01 ）. Multivariate logistic regression analysis showed that smoking （ OR = 2. 667, 95%CI 1.048 to 6. 791, P=0.040） and mRS score ≥ 3 （OR=8.690, 95%C13.279 to 23.031 ; P = 0. 000） were the indep

关 键 词：颈动脉狭窄 颈动脉内膜切除术 危险因素 并发症 

分 类 号：R743.3[医药卫生—神经病学与精神病学]