复合手术治疗症状性椎动脉颅外段闭塞的初步观察  

Preliminary observation on hybrid surgery for symptomatic extracranial vertebral artery occlusion

作　　者：郑秉杰[1] 王春雷[1] 张志远[2] 吴培[1] 季智勇[1] 姚金彪 徐善才[1] 史怀璋[1] Zheng Bingjie;Wang Chunlei;Zhang Zhiyuan;Wu Pei;Ji Zhiyong;Yao Jinbiao;Xu Shancai;Shi Huaizhang(Department of Neurosurgery,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China;Department of Neurosurgery,the First Hospital of Qiqihar City,Qiqihar 161005,China)

机构地区：[1]哈尔滨医科大学附属第一医院神经外科,哈尔滨150001 [2]齐齐哈尔市第一医院神经外科,齐齐哈尔161005

出　　处：《中华神经外科杂志》2023年第5期462-465,共4页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81901190)。

摘　　要：目的 探讨复合手术治疗症状性椎动脉颅外段闭塞的疗效.方法 回顾性分析2021年4月至2022年8月哈尔滨医科大学附属第一医院神经外科采用复合手术治疗的9例症状性椎动脉颅外段闭塞患者的临床资料.所有患者均采用椎动脉内膜切除术联合血管内治疗(复合手术).术后观察手术切口愈合、声带功能、瞳孔及眼睑活动情况.术后7 d内复查头颅MRI弥散加权成像(DWI)、椎动脉颅外段CT血管成像(CTA)或数字减影血管造影(DSA),出院时评估改良Rankin量表评分(mRS).术后3个月进行临床和影像学随访,临床随访内容包括mRS,以及后循环缺血性卒中、死亡事件;影像学随访方法包括CTA或DSA.结果 9例患者的椎动脉颅外段均成功再通,术中出现血管夹层1例.9例患者均置入支架,其中置入1枚1例,2枚3例,3枚5例.术后无一例发生症状性或无症状性脑梗死.术后出现Homer综合征2例,声音嘶哑2例,局部切口感染1例.复查椎动脉颅外段CTA结果显示,8例血管再通良好,1例出现无症状性血管闭塞.出院时mRS 0分7例,1分2例.9例患者的随访时间为3~18个月.至末次随访,mRS 0分7例,1分2例,9例患者均未出现后循环新发脑梗死;8例患者的椎动脉血流通畅.结论 初步观察发现,复合手术治疗症状性椎动脉颅外段闭塞患者的疗效较好,且具有一定的安全性.Objective To evaluate the efficacy of hybrid surgery for symptomatic extracranial vertebral artery occlusion.MethodsA retrospective analysis was conducted on the clinical data of 9 patients with symptomatic extracranial vertebral artery occlusion who underwent hybrid surgery at the Department of Neurosurgery,the First Affiliated Hospital of Harbin Medical University from April 2021 to August 2022.All patients were treated with vertebral artery endarterectomy combined with endovascular treatment(hybrid surgery).Incision healing,vocal cord function,pupil and eyelid movement were observed after surgery.Head MRI diffusion weighted imaging(DWI),extracranial vertebral artery CT angiography(CTA)or digital subtraction angiography(DSA)was reviewed within 7 days after surgery,and the modified Rankin scale(mRS)score was recorded at discharge.Clinical and imaging follow-up was performed 3 months after surgery,including posterior circulation ischemic stroke,mRS score and death events.Imaging follow-up included CTA or DSA.ResultsThe extracranial vertebral artery was recanalized successfully in all 9 patients and intraoperative vascular dissection occurred in 1 case.All patients were implanted with stents,with 1 stent in 1 patient,2 stents in 3 patients,and 3 stents in 5 patients.There was no symptomatic or asymptomatic cerebral infarction.Horner syndrome occurred in 2 patients,hoarseness in 2 patients,and local incision infection in 1 patient after surgery.Extracranial vertebral artery CTA reexamination results showed that 8 patients achieved successful recanalization while 1 case had asymptomatic vascular occlusion.At discharge,the mRS score was 0 in 7 patients and 1 in 2 patients.The follow-up period of the 9 patients was 3-18 months.The mRS score was O in 7 patients and 1 in 2 patients.There was no new cerebral infarction occurring in the 9 patients.The vertebral artery was patent in 8 patients.Conclusion Preliminary observations have found that hybrid surgery is effective and relatively safe in the treatment of patients wi

关 键 词：椎动脉 闭塞性动脉硬化 复合手术 症状性 

分 类 号：R651.12[医药卫生—外科学]