改良外翻式颈动脉内膜切除术100例临床分析  

Clinical results of 100 cases of modified eversion carotid endarterectomy

作　　者：倪冷[1] 练文卓 曾嵘[1] 狄潇[1] 宋希涛[1] 李方达[1] 崔立强[1] 孙国强[2] 郑月宏[1] 刘昌伟[1] Ni Leng;Lian Wenzhuo;Zeng Rong;Di Xiao;Song Xitao;Li Fangda;Cui Liqiang;Sun Guoqiang;Zheng Yuehong;Liu Changwei(Department of Vascular Surgery,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing100730,China;Information Center,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院血管外科,北京100730 [2]中国医学科学院,北京协和医学院,北京协和医院信息中心,北京100730

出　　处：《中华外科杂志》2024年第12期1143-1149,共7页Chinese Journal of Surgery

基　　金：中国医学科学院医学与健康科技创新工程经费资助项目(2022-I2M-1-019);北京协和医院中央高水平医院临床科研专项(2022-PUMCH-A-079)。

摘　　要：目的探讨改良外翻式颈动脉内膜切除术的安全性及有效性。方法本研究为回顾性病例系列研究。回顾性分析2019年1月至2023年12月北京协和医院血管外科由同一术者连续主刀的100例改良外翻式颈动脉内膜切除术患者的病历资料。男性77例,女性23例,年龄(66.0±8.6)岁(范围:39~85岁)。其中症状性颈动脉狭窄且狭窄程度>50%的患者24例(24.0%),无症状颈动脉狭窄且狭窄程度>70%的患者76例(76.0%)。患者均符合颈动脉内膜切除术的手术指征。该术式与传统外翻式内膜剥脱术的主要区别在于,术中自颈内动脉起始处向颈总动脉方向斜行切开颈内动脉前壁、外侧及后壁,保留颈内动脉分叉侧血管壁的连续完整性。记录患者手术过程、在院期间心脑血管及其他手术相关并发症情况。收集随访期间并发症发生情况、术侧靶病变再狭窄及再干预情况。结果患者均顺利完成手术,手术时间(36.5±10.1)min(范围:22~65 min),术中颈动脉阻断时间(15.0±6.3)min(范围:7~31 min)。术后1例(1.0%)患者发生急性脑缺血症状,1例(1.0%)患者出现脑过度灌注综合征,1例(1.0%)患者发生心肌梗死,上述患者经药物治疗后均在1周内恢复。患者随访时间[M(IQR)]24(28)个月(范围:6~62个月)。随访期间2例(2.0%)患者发生再狭窄,其中1例行颈动脉支架植入术。无术侧缺血性脑卒中发生。结论改良外翻式颈动脉内膜切除术安全有效,颈动脉阻断时间较短,缺血性脑卒中发生率较低;同时,该术式保留了颈内动脉分叉处外膜的完整性,可降低再狭窄率,并减少颈动脉体和颈动脉窦神经损伤,对预防术后脑过度灌注综合征的发生有一定帮助。Objective The primary goal of this study is to explore the safety and effectiveness of a new modified eversion carotid endarterectomy(MECEA).Methods This is a retrospective case series study.One hundred patients were consecutively treated with MECEA by the same operator at Department of Vascular Surgery,Peking Union Medical College Hospital from January 2019 to December 2023.There were 77 males and 23 females.The age was(66.0±8.6)years(range:39 to 85 years).Twenty-four(24.0%)patients were symptomatic with the degree of carotid stenosis over 50%,76 patients(76.0%)were asymptomatic with the degree of stenosis over 70%.All these patients meet the indication of carotid endarterectomy.The main difference between MECEA and traditional eversion carotid endarterectomy was the anterior,lateral,and posterior walls of the internal carotid artery were incised obliquely from the origin of the internal carotid artery toward the common carotid artery,leaving the wall of internal carotid artery intact at the bifurcation.The surgical process,cardiovascular and cerebrovascular complications and other surgical complications were recorded.The incidences of complications,restenosis of intraoperative target lesions and re-intervention were collected during follow-up.Results All procedures were performed successfully under general anesthesia.The total operation time was(36.5±10.1)minutes(range:22 to 65 minutes),and carotid clamping time was(15.0±6.3)minutes(range:7 to 31 minutes).One patient(1.0%)occurred postoperative cerebrovascular accident,1 patient(1.0%)developed cerebral hyperperfusion syndrome(CHS),and another 1 patient(1.0%)suffered myocardial infarction.All these patients were recovered after medical treatment within a week.The follow-up time(M(IQR))was 24(28)months(range:6 to 62 months).Two patients(2.0%)were reported to have hemodynamically significant restenosis within 2 years,with one patient requiring intervention.No patient suffered from ipsilateral ischemic stroke.Conclusion sMECEA is a safe and effective surgical me

关 键 词：颈动脉狭窄 颈动脉内膜切除术 改良外翻术式 颈动脉窦神经 

分 类 号：R651.12[医药卫生—外科学]