颈动脉内膜切除手术技巧及围手术期处理：多中心临床经验总结  

Surgical techniques and perioperative management of carotid endarterectomy multi-center clinical experience at home and abroad

作　　者：曲乐丰[1] 柏骏[1] Dieter Raithel 陈东[3] 王继跃[4] 毛更生[5] 陈立朝[6] 韩光良[7] 柳尧林[8] 梁勇[9] 黄亚波[10] 

机构地区：[1]第二军医大学上海长征医院血管外科,200003 [2]德国纽伦堡医院血管外科 [3]大连市中心医院神经外科 [4]聊城市人民医院神经外科 [5]武警总医院神经外科 [6]重庆大坪医院神经外科 [7]胜利油田中心医院神经外科 [8]莱州市人民医院胸心血管外科 [9]沈阳军区总医院神经外科 [10]苏州大学附属第一医院神经外科

出　　处：《中华神经外科杂志》2014年第11期1104-1107,共4页Chinese Journal of Neurosurgery

基　　金：上海市科委“创新行动计划”基础研究（12JC1411202）;上海市高校“东方学者”特聘教授基金

摘　　要：目的 总结国内外多中心3 226例次颈动脉内膜切除术（CEA）治疗颅外段颈动脉粥样硬化狭窄手术技巧及围手术期处理.方法 回顾分析2005年5月至2013年5月国内外多中心收治的3 012例颈动脉狭窄患者,共完成CEA 3 226例次,总结围术期处理经验,探讨手术方式及操作技巧.结果 3 226例次CEA手术均成功,2 910例（90.2％）行外翻式CEA （EEA）,316例（9.8％）行补片式CEA （pCEA）,平均阻断时间（15.5±2.0） min,平均手术时间（50.5 ±5.0） min.112例使用沿皮纹横切口.围术期死亡3例,脑梗死2例,同侧脑出血1例,切口血肿28例,1例术后出现严重神经精神症状,认知障碍,1例发生下颌小关节脱位,术后代偿;脑神经损伤6例,其中舌下神经损伤4例,面神经下颌支损伤2例.81例高危因素患者CEA手术成功,术后均无严重并发症及死亡发生.结论 CEA是治疗颈动脉狭窄预防卒中安全、有效的方法,完善的围手术期管理及“4S＋1D”原则是CEA成功的关键.EEA操作简捷、手术及阻断时间短,无需补片及转流管,费用低廉,值得推广.Objective To summarize multi-center clinical experiences of surgical techniques and perioperative management of 3 226 cases of carotid endarterectomy （CEA） to treat extracranial carotid atherosclerotic stenosis.Methods Retrospective analysis to explore the operation plan and skill and summarize the key point of peri-operation management was performed for experience of 3 226 cases of CEA performed in multicenter during eight years from May 2005 to May 2013.Results All of 3 226 cases of CEA performed successfully.Among which,2 910 cases （90.2％） were EEA,and 316 cases （9.8％） were pCEA.The average carotid clamping time was （15.5 ± 2.0） min.The average operation time was （50.5 ± 5.0） min.There were 3 case of death after CEA,2 cases of cerebral infarction,ipsilateral cerebral hemorrhage in 1 case,28 cases of incision hematoma,1 case of patients with postoperative severe nerve mental symptoms and cognitive impairment,1 case of small jaw joint dislocation ; cranial nerve injury in 6 cases,including 4 cases of hypoglossal nerve injury,facial nerve mandible injury in 2 cases.There were no serious postoperative complications and death occurred in 81 patients with high-risk factors.Conclusions CEA is a safe and effective treatment to cure extracranial carotid atherosclerotic stenosis.Perfect perioperative management and principles of ＂4 S ＋ 1 D＂ are the key to the success of the CEA.EEA is worth promoting because of its simplicity of operation,operation and blocking time is short,don＇t need shunt and patch,cost is low.

关 键 词：颈动脉粥样硬化狭窄 颈动脉内膜切除术 外翻式颈动脉内膜切除术 补片式颈动脉内膜切除术 手术技巧 

分 类 号：R654.3[医药卫生—外科学]