颈总动脉-锁骨下动脉搭桥术治疗症状性锁骨下动脉闭塞的临床疗效  

The clinical efficacy of common carotid artery-subclavian artery bypass in the treatment of symptomatic subclavian artery occlusion

作　　者：崔小鹏[1,2] 赵岩 汪邦月[1] 候长凯 刘兵 雪亮 魏伟[1] 岳树源[1] 杨新宇[1] Cui Xiaopeng;Zhao Yan;Wang Bangyue;Hou Changkai;Liu Bing;Xue Liang;Wei Wei;Yue Shuyuan;Yang Xinyu(Department of Neurosurgery,General Hospital of Tianjin Medical University,Tianjin Institute Neurology,Tianjin 300052,China;Department of Neurosurgery,Tianjin Fifth Central Hospital(Peking University,Binhai Hospital),Tianjin 300450,China)

机构地区：[1]天津医科大学总医院神经外科,天津市神经病学研究所,300052 [2]天津市第五中心医院(北京大学滨海医院)神经外科,300450

出　　处：《中华神经外科杂志》2021年第11期1136-1140,共5页Chinese Journal of Neurosurgery

基　　金：天津市科学技术委员会重点项目(20JCZDC00300);天津医科大学临床研究项目(2018kylc008)

摘　　要：目的探讨采用颈总动脉-锁骨下动脉(SA)搭桥术治疗有脑缺血症状的SA闭塞患者的临床疗效。方法纳入2015年1月至2020年6月天津医科大学总医院神经外科于复合手术室行颈总动脉-SA搭桥术的11例SA闭塞患者, 所有患者均有脑缺血症状。回顾性分析患者的临床疗效及手术相关并发症。结果所有患者均手术成功, 术中超声及数字减影血管造影(DSA)提示椎动脉盗血消失, 吻合血管通畅。2例患者术中显露SA时, 发生淋巴管破裂。无一例患者发生神经损伤及卒中。术后1年随访, 所有患者SA盗血综合征症状明显改善或消失。双上肢收缩压差由术前的(27.6±9.7)mmHg降至术后的(7.3±1.9)mmHg(P<0.01, 1 mmHg=0.133 kPa), 患侧与健侧收缩压比值由术前的0.55±0.11提高至0.86±0.30(P<0.01)。所有患者人工血管及吻合口无明显狭窄, 患侧无肢体缺血及脑缺血表现。结论颈总动脉-SA治疗有脑缺血症状的SA闭塞患者手术并发症少、疗效确切。Objective To explore the treatment efficacy of common carotid-subclavian artery(SA)bypass in the patients with cerebral ischemia resulting from SA occlusion.Methods This study enrolled 11 SA-occlusion patients who underwent common carotid artery-subclavian artery bypass in the hybrid operating room at the Department of Neurosurgery,General Hospital of Tianjin Medical University from January 2015 to June 2020.All patients had symptoms of cerebral ischemia.A retrospective analysis was conducted on the clinical effect on those patients and surgical-related complications.Results All patients underwent successful operation.Intraoperative ultrasound and digital subtraction angiography(DSA)indicated that the vertebral artery steal syndrome disappeared and the anastomoses were unobstructed.Two patients had lymphatic rupture when SA was dissected during the operation.None of the patients had nerve damage or stroke.At 1-year follow-up,the symptoms of SA steal syndrome were significantly improved or disappeared in all patients.The systolic pressure difference of the upper limbs decreased from 27.6±9.7 mmHg before operation to 7.3±1.9 mmHg after operation(P<0.01,1 mmHg=0.133 kPa),and the ratio of systolic blood pressure of the patient on the affected side to that on the uninfected side increased from 0.55±0.11 before operation to 0.86±0.30(P<0.01).All patients had no obvious stenosis of artificial blood vessels or anastomoses,no limb ischemia or cerebral ischemia on the affected side.Conclusion Common carotid-SA bypass is a safe and effective treatment for cerebral ischemia caused by SA occlusion.

关 键 词：锁骨下动脉 动脉硬化 闭塞性 治疗结果 颈总动脉-锁骨下动脉血管重建 

分 类 号：R651.12[医药卫生—外科学]