547例单中心大样本颈动脉内膜切除术围手术期手术并发症分析  

A single center large cohort study on perioperative complications of carotid endarterectomy of 547 cases

作　　者：孙伟军 高法梁 亓旭晨[2] 王义荣[2] 彭德清[1] 吴骋 金晓[1] 陈书达[1] Sun Weijun;Gao Faliang;Qi Xuchen;Wang Yirong;Peng Deqing;Wu Cheng;Jin Xiao;Chen Shuda(Department of Neurosurgery, Zhejiang Provincial People＇s Hospital, People＇s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, China)

机构地区：[1]浙江省人民医院、杭州医学院附属人民医院神经外科,杭州310014 [2]浙江大学医学院附属邵逸夫医院神经外科

出　　处：《中华医学杂志》2018年第29期2331-2335,共5页National Medical Journal of China

基　　金：浙江省医药卫生科技计划项目（2016146786）

摘　　要：目的 分析颈动脉内膜切除术（CEA）在治疗动脉粥样硬化性颈动脉狭窄中的术后30 d内并发症及术后并发症发生的危险因素,并对如何降低术后并发症进行探讨.方法 回顾性纳入在浙江省人民医院和浙江大学医学院附属邵逸夫医院2011年8月至2017年8月期间治疗的486例动脉粥样硬化性颈动脉狭窄患者,其中61例分期行双侧CEA,每例按2例单独病例进行统计,共计547例.分析术后30 d并发症,并采用单因素和多因素分析术后相关并发症的危险因素.结果在547例手术患者中,共12例发生了脑卒中或心梗事件,1例患者死亡.共7例发生了颅神经损伤.需外科处理的切口相关并发症5例.χ^2检验分析结果提示合并心脏疾病（P=0.013）、术前神经功能评分差（P=0.001）、合并对侧颈动脉重度狭窄或闭塞（P=0.001）以及术中需要转流（P=0.009）的患者在卒中和死亡相关并发症的发生率方面差异有统计学意义（P〈0.05）;多因素回归结果分析提示,术前mRS评分（P=0.020,OR=0.223）及合并对侧颈动脉重度狭窄或闭塞（P=0.013,OR=4.395）为CEA术后卒中和死亡相关并发症发生的独立危险因素.结论 CEA治疗颈动脉粥样硬化性狭窄安全有效,通过术前严格选择手术病例,术中多模式的脑灌注监测可提高手术的安全性,减少手术并发症. 术前神经功能评分差以及对侧颈动脉重度狭窄或闭塞患者会增加术后并发症发生风险.Objective To analyze the risk factors of perioperative complications within 30 days of carotid endarterectomy（CEA） in the treatment of carotid atherosclerosis stenosis（CAS） during 2011 - 2017, and to discuss the techniques for reducing the perioperative complication rates. Methods From August 2011 to August 2017, 486 patients with CAS were retrospective included, and 61 of them underwent bilateral CEA, with a total of 547 cases of CEA included. Perioperative complications were collected within 30 days after operation, and the risk factors related to perioperative complications were analyzed by statistical analysis. Results In total 547 cases, 12 cases had a postoperative stroke, while 1 case died. A total of 7 cases underwent cranial nerve injury, and 5 cases had an incision related complications. In chi-square test analysis, data suggested that there was a significant difference in the incidence of complications in patients with heart disease, preoperative neurological score difference, contralateral carotid serious stenosis or occlusion and intraoperative shunt in CCA/ICA technique application （ P 〈 0.05 ）. In the multivariate Logistic regression, it suggested that poor preoperative neurological score and contralateral carotid serious stenosis or occlusion were independent risk factors for perioperative stroke and death. Conclusion Our results showed that CEA is effective to prevent stroke and treat patients with CAS. Patients with poor preoperative neurological score and contralateral carotid serious stenosis or occlusion may increase the risk of postoperative stroke rates.

关 键 词：颈动脉内膜切除术 颈动脉狭窄 动脉粥样硬化 脑缺血 手术后并发症 

分 类 号：R651.12[医药卫生—外科学]