颈动脉内膜切除术治疗高分叉颈动脉狭窄的疗效分析  

Effect analysis of carotid endarterectomy for high bifurcation carotid artery stenosis

作　　者：司俊臣 于凯[2] 林凯[1] 蒋群龙 尹国阳[1] 郝继恒[1] 王继跃[1] 张利勇[1] Si Junchen;Yu Kai;Lin Kai;Jiang Qunlong;Yin Guoyang;Hao Jiheng;Wang Jiyue;Zhang Liyong(Department of Neurosurgery,Liaocheng People's Hospital,Liaocheng 252000,China;Department of Burn Plastic Surgery,Liaocheng People's Hospital,Liaocheng 252000,China)

机构地区：[1]聊城市人民医院神经外科,聊城252000 [2]聊城市人民医院烧伤整形外科,聊城252000

出　　处：《中华神经医学杂志》2022年第2期139-144,共6页Chinese Journal of Neuromedicine

摘　　要：目的探讨对高分叉颈动脉狭窄患者施行颈动脉内膜切除术的临床疗效及安全性。方法选择聊城市人民医院神经外科自2017年1月到2020年1月收治的169例于手术显微镜下施行颈动脉内膜切除术的颈动脉狭窄患者(147例为非高分叉颈动脉狭窄,22例为高分叉颈动脉狭窄)进入研究,其中高分叉颈动脉狭窄患者术中采用切断二腹肌后腹辅助暴露颈内动脉斑块远端;术后1周内行颈部CTA/DSA检查明确颈动脉狭窄是否完全解除,术后半年和1年时行颈部血管超声复查明确颈动脉是否再狭窄。回顾性比较2组患者在手术疗效、围手术期并发症及复查结果方面有无差异。结果2组患者术后颈动脉狭窄均完全解除;2组患者间新发脑梗死、暂时性神经功能损伤发生比例(4.5%vs.2.0%;9.1%vs.3.4%)的差异均无统计学意义(P>0.05);2组患者均未发现颈动脉再狭窄,高分叉颈动脉狭窄组患者的二腹肌功能无明显异常。结论颈动脉内膜切除术中切断二腹肌后腹能够较好地暴露高分叉颈动脉狭窄患者颈内动脉斑块远端,从而为有效解除颈动脉狭窄提供便利,且安全性较高。Objective To explores the clinical efficacy and safety of carotid endarterectomy in patients with high bifurcation carotid artery stenosis.Methods A total of 169 patients with carotid artery stenosis(147 patients with non-high bifurcation carotid artery stenosis and 22 patients with high bifurcation carotid artery stenosis),underwent carotid endarterectomy under surgical microscope in our hospital from January 2017 to January 2020,were included in the study.Patients with high bifurcation carotid artery stenosis were operated by cutting off the posterior abdomen of the digastric muscle to assist in exposing the distal end of the internal carotid artery plaque.Cervical CTA/DSA examination was performed within one week of surgery to confirm whether carotid artery stenosis was relieved;ultrasound examination of cervical vessels was performed 6 months and 1 year after surgery to determine whether restenosis was appeared in the carotid artery.The surgical efficacy,perioperative complications and re-examination results were compared between the two groups.Results Postoperative carotid artery stenosis was relieved in both groups.The proportions of new cerebral infarction and temporary neurological impairment between the two groups(4.5%vs.2.0%;9.1%vs.3.4%)showed no significant differences(P>0.05).Carotid artery restenosis was not found in both groups.There was no obvious functional abnormality in the digastric muscles of patients with high bifurcation carotid stenosis.Conclusion Cutting off the posterior abdomen of the digastric muscle during carotid endarterectomy can better expose the distal end of the internal carotid plaque in patients with high bifurcation carotid stenosis,and provide convenience for effective relief of carotid artery stenosis with high safety.

关 键 词：颈动脉狭窄 高分叉 颈动脉内膜切除术 二腹肌后腹 

分 类 号：R743.3[医药卫生—神经病学与精神病学]