跨中线经椎前间隙入路锁骨下动脉-颈总动脉血管旁路移植治疗颈总动脉闭塞  

Treatment of common carotid artery occlusion by transmidline subclavian artery-common carotid artery bypass through the prevertebral space

作　　者：吴超[1] 王涛[1] Chao Wu;Tao Wang(Department of Neurosurgery,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院神经外科,100191

出　　处：《中华脑血管病杂志（电子版）》2023年第1期16-21,共6页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：国家自然科学基金(82071308);北京市自然科学基金(7192219)。

摘　　要：目的总结跨中线经椎前间隙入路锁骨下动脉-颈总动脉血管旁路移植治疗颈总动脉闭塞的技术要点,评估其可行性和有效性。方法针对1例症状性的左侧颈总动脉闭塞患者,在全身麻醉下行右侧锁骨下动脉-左侧颈总动脉人工血管旁路移植术,经颈前间隙建立人工血管的经过通道,总结此手术技术治疗颈总动脉闭塞的技术要点及手术效果。结果该例患者的手术时间为205 min,术中出血量为30 ml。经椎前间隙入路行右侧锁骨下动脉-左侧颈总动脉人工血管旁路移植术后,左侧颈内动脉血流恢复通畅,术后无过度灌注综合征及其他脑血管并发症,无声音嘶哑、饮水呛咳及吞咽困难等颈部手术并发症。术后10 d患者康复出院,出院后随访3个月,建立的血管旁路及左侧颈内动脉系统通畅,左侧脑灌注较术前改善,未再发生头晕黑矇等脑缺血症状。结论跨中线经椎前间隙入路锁骨下动脉-颈总动脉血管旁路移植术技术可行,适用于治疗复杂慢性颈总动脉闭塞患者。Objective To summarize the technical points of transmidline subclavian artery-common carotid artery bypass through the prevertebral space for the treatment of common carotid artery occlusion,and to evaluate its feasibility and effectiveness.Methods For a patient with symptomatic left common carotid artery occlusion,right subclavian artery-left common carotid artery artificial blood vessel bypass was performed under general anesthesia.The passage of artificial blood vessel was established through the cervical prevertebral space,and the technical points and surgical effects of this surgical technique for common carotid artery occlusion were summarized.Results The operative time of the patient was 205 min and the intraoperative blood loss was 30 ml.After the right subclavicular artery-left common carotid artery artificial vessel bypass through the prevertebral space approach,the left internal carotid artery blood flow was restored and unobtrusive,and there were no postoperative hyperperfusion syndrome and other cerebrovascular complications,and no postoperative complications of neck surgery such as hoarseness,drinking cough,and dysphagia.The patient recovered and was discharged from the hospital 10 days after surgery,and was followed up at 3 months after discharge.The established vascular bypass and left internal carotid artery system were unobstructed.The left cerebral perfusion was improved compared with that before surgery.No cerebral ischemia symptoms such as dizziness and amaurosis occurred again.Conclusion Transmidline subclavian artery-common carotid artery bypass through the prevertebral space is feasible and suitable for the treatment of complex common carotid artery occlusion.

关 键 词：颈总动脉 动脉闭塞性疾病 人工血管 移植 锁骨下动脉 

分 类 号：R651.1[医药卫生—外科学]