复合手术在颈动脉近全闭塞治疗中的应用  

Application of hybrid operation in the treatment for near total occlusion of carotid artery

作　　者：李华超 张涛 高恺明[2] 佟小光[2] LI Hua-chao;ZHANG Tao;GAO Kai-ming;TONG Xiao-guang(Graduate School,Tianjin Medical University,Tianjin 300070,China;Department of Neurosurgety,Tianjin Huanhu Hospital,Tianjin 300350,China)

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津市环湖医院神经外科,天津300350

出　　处：《天津医科大学学报》2018年第5期444-447,共4页Journal of Tianjin Medical University

摘　　要：目的:探讨复合手术对颈动脉近全闭塞患者治疗的可行性及效果。方法:回顾性分析32例诊断为颈动脉近全闭塞患者通过复合手术治疗的临床资料,其中12例患者行颈动脉内膜剥脱术(CEA)及脑血管造影(DSA)治疗,20例患者接受经CEA联合球囊或支架成形术。结果:所有患者术后DSA均显示狭窄基本解除,远端显影较术前好转,脑部低灌注区得到不同程度改善。患者围手术期均未出现脑出血、脑梗死等严重并发症。其中3例患者术后出现轻度过灌注综合征,对症处理后好转。所有患者随访≥3个月,随访最长22个月,均未出现严重心脑血管事件,有1例患者术后6个月复查主动脉弓-颅内血管成像(CTA)提示术侧颈内动脉(ICA)闭塞,但无缺血症状,继续随访。结论:颈动脉近全闭塞患者进行复合手术治疗安全可行,可以弥补单一行CEA或血管内治疗的不足,但仍需大样本及长期随访进行评价。Objective： To investigate the feasibility and effectiveness of hybrid operation in the treatment for patients with near occlusion of carotid artery. Methods：The clinical data of 32 patients diagnosed with near occlusion of carotid artery and with hybrid treated were analyzed retrospectively. Carotid endartereetomy （CEA） combined with digital subtraction angiography （DSA） were performed in 12 patients and CEA plus carotid balloon or stenting in 20 patients according to the specific lesions. Results： Good artery morphology, smooth blood flow and improved cerebral perfusion were achieved in all patients based on DSA and MRI perfusion reexamination after the operation. Three patients suffered from hyperperfusion syndrome but all patients had no complications of cerebral hemorrhage or cerebral infarction during the perioperative period. The duration of follow-up was 3 to 22 months, no serious cardiovascular events occurred, and 1 patient had occlusion of internal carotid artery （ICA） detected by CT angiography after 6 months. Follow-up was performed due to absence of cerebral isehemia. Conclusion：This study proves that hybrid operation for patients with near occlusion of carotid artery is safe and feasible, but still needs more sample data and long-tern1 follow-up to prove its effect.

关 键 词：复合手术 动脉闭塞性疾病 颈动脉内膜剥脱术 支架成形术 

分 类 号：R651.11[医药卫生—外科学]