颈动脉内膜剥脱改良根治术(分叉上移术)初步探索  

Preliminary exploration of modified surgical technique in carotid endarterectomy(bifurcation ascension)

作　　者：向文轩 狄潇[1,2] 李方达 刘晓龙[1,2] 张慧 王磊 曾嵘[1,2] 王子建 周磊[1,2] 向涛 郑月宏[1,2] Xiang Wenxuan;Di Xiao;Li Fangda;Liu Xiaolong;Zhang Hui;Wang Lei;Zeng Rong;Wang Zijian;Zhou Lei;Xiang Tao;Zheng Yuehong(Department of Vascular Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100730,China;State Key Laboratory of Complex Severe and Rare Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院血管外科,北京100730 [2]中国医学科学院北京协和医院疑难重症及罕见病国家重点实验室,北京100730

出　　处：《血管与腔内血管外科杂志》2023年第2期129-133,139,共6页Journal of Vascular and Endovascular Surgery

基　　金：中央高水平医院临床科研专项(2022-PUMCH-B-100);国家自然科学基金(82070492)。

摘　　要：颈动脉内膜剥脱术(CEA)是治疗颅外段颈动脉狭窄、预防缺血性脑卒中发生的重要手术方式。经过70年的发展,CEA的有效性和安全性已通过多项大型临床随机对照试验验证,并衍生出多种手术方式。传统CEA的颈动脉切口为颈总动脉至颈内动脉的纵向切口,由于直接原位缝合术后易发生再狭窄,因而通常需使用补片。目前,临床主要应用的术式是补片成形CEA和外翻式CEA,各有优劣,关于其手术经验和改良方案已有研究报道。颈动脉内膜剥脱改良根治术(分叉上移术)是结合CEA的手术原理及临床经验而提出的手术方式,其特点在于无需使用补片,术后的融合管腔直径大,具备临床研究价值,但较难处理高位颈动脉病变,其有效性、安全性及适用人群尚需进一步进行临床试验的探索。由于重建颈动脉分叉,该术式也具有推广至其他累及颈动脉分叉的颈部病变(如颈动脉体瘤)的潜在价值。本文主要针对其应用背景、临床应用现状及技术要点加以述评,以期能够为临床工作和研究提供参考。Carotid endarterectomy(CEA)is an essential surgical technique to treat extracranial carotid stenosis and prevent ischemic stroke.CEA has evolved over the past 70 years,with its effectiveness and safety being validated in several large randomized controlled trials and various modified techniques emergent.Conventional CEA used a longitudinal incision from the common carotid artery to the internal carotid artery,which was prone to restenosis after direct suturing and a patch was necessary.Currently,the main procedures in clinical practice are CEA with patch angioplasty and eversion CEA,both of which have advantages and disadvantages.Research has been reported on the surgical experience and modified techniques of CEA.The modified surgical technique in carotid endarterectomy(bifurcation ascension)combines the principles of carotid endarterectomy with clinical expertise.It is characterized by the absence of patch use and the sizeable postoperative fusion lumen,which has clinical value.It is difficult for the modified CEA to treat carotid lesions in superior position,so the effectiveness,safety and suitable population should be explored by clinical trials.Because of the reconstruction of the carotid bifurcation,this procedure also has the potential to deal with other carotid lesions involving the carotid bifurcation,such as carotid body tumors.In this article,the background,current clinical application,and technical points are reviewed with the intention of providing reference for clinical work and research.

关 键 词：颈动脉狭窄 外科技术 颈动脉内膜剥脱术 分叉上移术 

分 类 号：R543[医药卫生—心血管疾病]