沿皮纹横切口与经胸锁乳突肌前缘斜切口在颈动脉内膜切除术的前瞻性对照研究  

A prospective controlled study on transverse incision along the dermatographs and oblique incision at the anterior sternocleidomastoid muscle border for carotid endarterectomy

作　　者：柏骏[1] 曲乐丰[1] 职康康[1] 高志伟[1] 邹思力[1] 吴永发[1] 王亮[1] 金杰[1] 

机构地区：[1]第二军医大学附属长征医院血管外科,上海200003

出　　处：《中国微侵袭神经外科杂志》2014年第5期199-202,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：上海市科委"创新行动计划"基础研究重点项目(编号:12JC1411202);上海市高校"东方学者"特聘教授基金

摘　　要：目的评价颈动脉内膜切除术(carotid endarterectomy,CEA)沿皮纹横切口的临床疗效及美观性。方法将2010年3月-2012年6月收治的200例颈动脉狭窄病人随机分为沿皮纹横切口组(横切口组)和经胸锁乳突肌前缘斜切口组(斜切口组),每组100例。比较手术操作及疗效,评估不同切口美观性及病人满意度。结果两组病例临床资料无统计学差异,包括手术时间、颈动脉阻断时间、切口长度、围手术期病死率、并发症发生率(P>0.05)。随访3、6、12个月,切口严重麻木在横切口组为34.0%、20.2%、16.0%,斜切口组为46.3%、33.7%、27.4%。切口满意度在横切口组为83.0%、87.2%、88.3%,斜切口组为33.7%、28.4%、25.3%。结论沿皮纹横切口可安全、有效施行各种术式CEA,术后皮肤麻木、切口美观性和满意度优于经胸锁乳突肌前缘斜切口。但其对高颈动脉分叉者的显露和切口延长不如后者。Objective To evaluate the clinical efficacy and aesthetics of carotid endarterectomy （CEA） with transverse incision along the dermatographs. Methods From March 2010 to June 2012, 200 patients with carotid stenosis were randomly divided into transverse incision group （n = 100） and anterior sternocleidomastoid muscle border incision group （oblique incision group, n = 100）. The efficacy of surgical procedures was compared. The aesthetics and patient satisfaction of different incisions were assessed. Results There was no significant difference between the two groups in the operation time, carotid artery occlusion time, incision length, perioperative mortality and complication rate （P 〉 0.05）. At the follow-up of 3, 6, 12 months, the rate of the incision severe numbness was 34.0%, 20.2%, 16.0% in transverse incision group and 46.3%, 33.7%, 27.4% in oblique incision group respectively, and the aesthetic satisfaction was 83.0%, 87.2%, 88.3% and 33.7%, 28.4%, 25.3% respectively. Conclusions CEA can be performed safely and effectively with transverse incision along the dermatographs, which produces less numbness in the skin, better cosmetic outcome and higher patient satisfaction than anterior sternocleidomastoid border incision, but is inferior to the latter in exposure of high carotid bifurcation＇ and prolong of the incision.

关 键 词：颈动脉内膜切除术 颈动脉狭窄 横切口 斜切口 

分 类 号：R654.3[医药卫生—外科学]