补片式颈动脉内膜剥脱术与外翻式颈动脉内膜剥脱术长期随访结果比较  

Comparison of patch carotid endarterectomy and eversion carotid endarterectomy:a retrospective study of long-term follow-up

作　　者：杨洋 闫盛 陈作观[1] 吴志远 刁永鹏 高擎[1] 陈跃鑫 郑月宏[3] 李拥军[1] Yang Yang;Sheng Yan;Zuoguan Chen;Zhiyuan Wu;Yongpeng Diao;Qing Gao;Yuexin Chen;Yuehong Zheng;Yongjun Li(Department of Vascular Surgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Vascular Surgery,Second Hospital of Shanxi Medical University,Taiyuan 030000,China;Department of Vascular Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100005,China)

机构地区：[1]北京医院血管外科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [2]山西医科大学附属第二医院血管外科,太原030000 [3]北京协和医院血管外科、中国医学科学院、北京协和医学院,北京100005

出　　处：《中华脑血管病杂志（电子版）》2023年第4期337-343,共7页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：中央保健基金项目(W2017BJ11);国家重点研发计划项目(2020YFC2008003)。

摘　　要：目的比较补片式颈动脉内膜剥脱术(p-CEA)与外翻式颈动脉内膜剥脱术(e-CEA)的长期疗效。方法回顾性分析2009年10月至2015年10月在北京协和医院血管外科接受颈动脉内膜剥脱术(CEA)治疗的颈动脉狭窄患者的临床资料(共计340例患者372例次手术,其中p-CEA为193例次,e-CEA为179例次),比较两种手术方式远期的全因死亡、心肌梗死、所有卒中及手术同侧卒中发生率,以及症状复发率。结果2组基线结果比较显示,p-CEA组患者高脂血症比例高于e-CEA组,差异有统计学意义(46.1%vs 34.6%,P=0.032)。在133个月的随访期间,p-CEA组的病死率、心肌梗死发生率均高于e-CEA组,卒中发生率、手术同侧卒中发生率均低于e-CEA组,但差异均无统计学意义(17.8%vs 13.8%,P=0.4855;7.8%vs 5.9%,P=0.360;12.8%vs 15.6%,P=0.228;4.3%vs 5.9%,P=0.282);2组在术后症状复发上,差异亦无统计学意义(χ2=0.198,df=15.622,P=0.85)。Kaplan-Meier分析显示,在第6年,2组之间术后再狭窄和术后死亡比较,差异无统计学意义(P=0.87;P=0.18);在第8年,2组之间术后死亡和卒中比较,差异无统计学意义(P=0.34;P=0.24)。结论p-CEA组和e-CEA组的远期死亡、心肌梗死、所有卒中和手术同侧卒中,以及术后症状复发等均无差异,均可作为治疗颈动脉狭窄的有效方法。Objective To compare long-term outcomes of patch carotid endarterectomy(p-CEA)and eversion carotid endarterectomy(e-CEA).Methods In a retrospective study,data on 340 patients(372 operations,p-CEA=193,e-CEA=179)who underwent carotid endarterectomy were collected between October 2009 and October 2015 in the Vascular Surgery Department of Peking Union Medical College Hospital.The long-term incidence of all-cause death,myocardial infarction,stroke,ipsilateral stroke,and recurrence of symptoms were compared between two groups during follow-up.Results The comparison of baseline results showed that the proportion of patients with hyperlipidemia in the p-CEA group was higher than that in the e-CEA group(46.1%vs 34.6%,P=0.032).During a maximum follow-up period of 133 months,there was no statistical difference between the p-CEA group and the e-CEA group in mortality(17.8%vs 13.8%,P=0.4855),myocardial infarction(7.8%vs 5.9%,P=0.360),stroke(12.8%vs 15.6%,P=0.228),ipsilateral stroke(4.3%vs 5.9%,P=0.282),and recurrence of symptoms(χ2=0.198,df=15.622,P=0.85).Kaplan-Meier analysis showed that there was no significant difference in postoperative restenosis and postoperative death at year 6 between e-CEA and p-CEA groups(P=0.87;P=0.18),and postoperative death and stroke at year 8 between e-CEA and p-CEA groups(P=0.34;P=0.24).Conclusion The adverse event rates in long-term follow-up showed no significant difference between the e-CEA and p-CEA groups.Both e-CEA and p-CEA are effective for carotid artery stenosis.

关 键 词：颈动脉内膜剥脱 补片式 外翻式 颈动脉狭窄 远期死亡 

分 类 号：R651.12[医药卫生—外科学]