显微外科手术治疗颈动脉狭窄并迂曲九例  

Microsurgical treatment of carotid artery stenosis combined with tortuosity: a series of nine cases

作　　者：张立成 陈福业 辛振学[1] 马金邦[1] 王传刚 彭涛[2] 王新志[1] Zhang Licheng;Chen Fuye;Xin Zhenxue;Ma Jinbang;Wang Chuangang;Peng Tao;Wang Xinzhi(Department of Neurosurgery,the Second People′s Hospital of Liaocheng,Liaocheng,Shandong 252600,China;不详)

机构地区：[1]山东省聊城市第二人民医院神经外科,252600 [2]山东省聊城市第二人民医院颅脑超声科,252600

出　　处：《中国脑血管病杂志》2024年第12期823-830,共8页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨颈动脉狭窄并迂曲患者显微外科手术治疗策略。方法回顾性连续纳入2019年6月至2023年8月于聊城市第二人民医院神经外科采用显微外科手术治疗的9例颈动脉狭窄并迂曲患者。收集患者一般资料和临床资料,包括基本信息(性别、年龄)、入院初步诊断、临床表现、颈动脉狭窄的危险因素(高血压病、糖尿病、高脂血症、吸烟、饮酒)、术前术侧及对侧血管影像学情况。根据血管迂曲类型分为以下3种手术方法:(1)颈内动脉“C”形迂曲采用斜行离断颈内动脉起始部,外翻剥离斑块,并向远端延长颈内动脉切口,近端延长颈总动脉切口,将颈内动脉下拉与颈总动脉行端侧吻合;(2)颈内动脉盘曲采用斜行离断颈内动脉起始部,外翻剥离斑块后切除颈内动脉起始段冗长部分并下拉与颈总动脉行端侧吻合;(3)颈内、颈外动脉均折曲或颈总动脉折曲采用横断颈总动脉后外翻剥离斑块,并切除部分颈总动脉,下拉颈内动脉和颈外动脉后,行颈总动脉端端吻合。所有患者术后1~3 d行颈部CT血管成像(CTA)和颈部血管超声,检查颈动脉通畅情况、迂曲改善程度及血流动力学变化。术后1~3 d颈部CTA、颈部血管超声评估残余狭窄率≤30%、迂曲改善、无卒中发生为手术成功。术后观察有无卒中、心肌梗死、声音嘶哑、手术切口出血、肿胀及愈合不良等并发症。术后1、6、12个月门诊复查颈动脉超声,评估再狭窄(收缩期峰值流速>220 cm/s,血管直径减少70%以上)情况。结果9例患者中男4例,女5例;年龄61~74岁,平均(67±4)岁。颈动脉无症状性重度狭窄3例,症状性中度狭窄3例,症状性重度狭窄3例。既往高血压病9例,糖尿病5例,高脂血症6例,冠心病4例,吸烟5例,饮酒4例。术侧颈内动脉“C”形迂曲5例,颈内动脉盘曲2例,颈内、颈外动脉均折曲1例,颈总动脉折曲1例。9例患者均顺利完成手术,术后1~3 d颈部Objective To explore the microsurgical treatment strategies for patients with carotid artery stenosis complicated by tortuosity.Methods A retrospective study was conducted on 9 patients with carotid artery stenosis and tortuosity who underwent microsurgical treatment in the Department of Neurosurgery,the Second People′s Hospital of Liaocheng,from June 2019 to August 2023.Patient demographics and clinical data,including sex,age,initial admission diagnosis,clinical symptoms,risk factors for carotid artery stenosis(hypertension,diabetes,hyperlipidemia,smoking,drinking),pre-operative and contralateral vascular imaging were collected.According to the type of vascular tortuosity,three surgical methods were employed:(1)For“C”-shaped tortuosity of the internal carotid artery(ICA),the ICA was divided obliquely at the carotid bifurcation,and eversion carotid endarterectomy was performed.Then ICA was opened longitudinally along its medial side,the common carotid artery(CCA)was extended proximally along its lateral border.The ICA was end-to-side anastomosis anastomosed to the CCA.(2)For coiling of the ICA,the ICA was divided obliquely at the carotid bifurcation and eversion carotid endarterectomy was completed.The redundant segment of the ICA origin was resected,and an end-to-side anastomosis between the ICA and CCA was performed.(3)For cases of kinking of both the ICA and external carotid artery(ECA),or kinking of the CCA,the technique was performed by transection of the CCA,and then eversion carotid endarterectomy was performed,and part of the CCA was resected.After downward mobilization of the ICA and ECA,an end-to-end anastomosis of the CCA was carried out.Postoperatively,all patients underwent neck CT angiography(CTA)and duplex ultrasound examination within 1-3 d to assess carotid patency,tortuosity improvement,and hemodynamic changes.Surgical success was defined as residual stenosis≤30%,improved tortuosity,and no occurrence of stroke within 1-3 d after surgery.Postoperative complications,including stroke,myocar

关 键 词：颈动脉狭窄 颈内动脉 显微外科手术 颈动脉迂曲 

分 类 号：R651.12[医药卫生—外科学]