一站式复合手术在症状性颈内动脉闭塞开通治疗中的初步应用  

Preliminary application of one-step hybrid operation in the treatment of carotid artery occlusion

作　　者：孙青[1] 黄亚波[1] 李波[1] 刘一之[1] 陈罡[1] Sun Qing;Huang Yabo;Li Bo;Liu Yizhi;Chen Gang(Department of Surgery,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院外科11区,苏州215006

出　　处：《中华医学杂志》2019年第12期943-946,共4页National Medical Journal of China

基　　金：江苏省社会发展项目-临床前沿技术(BE2017656).

摘　　要：目的探讨一站式复合手术(颈动脉内膜剥脱术联合血管内治疗手术)对颈内动脉闭塞开通的有效性及安全性。方法回顾性分析2016年2月至2018年2月在苏州大学附属第一医院手术治疗的症状性单侧颈内动脉闭塞患者的临床资料及随访资料,比较治疗前以及治疗后Barthel评分以及缺血性事件发生率,观察手术相关并发症的发生率,评估手术的安全性及有效性。结果复合手术开通颈动脉成功率90.5%,19例开通成功的病例术前Barthel评分为100(50,100),术前半年内缺血性事件发生率100%,术后随访时评分为100(85,100),术后至随访期间缺血性事件发生率5.3%,术前术后Barthel评分对比以及缺血性事件发生率对比差异均有统计学意义(均P<0.05),随访时间为6~32个月不等。开通成功后过度灌注发生率10.5%(2/19),医源性颈内动脉海绵窦瘘发生率9.5%(2/21),医源性颈动脉夹层4.8%(1/21),支架再狭窄率5.3%,这些并发症均得到妥善治疗。结论对于眼动脉以远显影的伴有相关缺血症状的颈内动脉闭塞病例,一站式复合手术可安全有效开通颈内动脉,恢复正向血流,改善患者预后,减少缺血性事件的发生率。Objective To evaluate the prognosis and surgical complication of the recanalization treatments for internal carotid artery (ICA) occlusion by using one-step hybrid carotid endarterectomy and endovascular surgery.Methods Retrospective analysis was performed on the clinical data and follow-up data of 22 patients with occluded ICA treated by one-step hybrid surgery.Difference in Barthel score and occurrence of ischemic stroke were compared with surgical group and conventional group which was treated by oral taking anti-platelet drugs.Further,the complications were analyzed to evaluate the safety and effectiveness of the surgery.Results The difference in ischemic event rate and Barthel scores improvement between the two groups were significant.Occlusive ICAs in 19 cases were recanalized successfully.The possibility of brain hyperperfusion related to the surgery was 10.5%(2/19) while the possibility of carotid artery cavernous fistula was 9.1%(2/22).We also observed rare dissecting ICA caused by the treatment (4.5%) and distal restenosis (5.3%).Conclusions One-step hybrid carotid endarterectomy and endovascular surgery could help recanalize the ICA,improve the blood supply and improve the prognosis.It′s a safe and effective treatment for ICA occlusion.

关 键 词：颈动脉闭塞 颈动脉内膜切除术 血管内治疗术 复合手术 

分 类 号：R651.1[医药卫生—外科学]