一站式颈动脉内膜剥脱术联合椎动脉转位术的临床研究分析

Carotid endarterectomy combined with vertebral artery transposition treating vertebral artery V1 segment stenosis combined with ipsilateral carotid artery stenosis

目的探索一站式颈动脉内膜剥脱术联合椎动脉转位术在同侧颈动脉重度狭窄至闭塞合并椎动脉V1段重度狭窄至闭塞患者中的治疗效果。方法回顾性分析2017年6月—2020年9月阜外医院采用一站式颈动脉内膜剥脱术联合椎动脉转位术治疗同侧颈动脉重度狭窄至闭塞合并椎动脉V1段重度狭窄至闭塞患者的临床资料。进而分析一站式颈动脉内膜剥脱术联合椎动脉转位术在同侧颈动脉重度狭窄至闭塞合并椎动脉V1段重度狭窄至闭塞治疗中的意义。结果纳入患者12例,其中男10例、女2例,平均年龄(67.8±6.0)岁。全部患者手术均成功。随访时间为1~3年,术后患侧椎动脉V1段的狭窄程度由83.5%±11.8%下降至24.9%±14.3%(P<0.001),术后患侧颈动脉狭窄程度由85.6%±11.0%下降至0%(P<0.001)。术后随访显示术前有症状的患者症状较术前均有改善,1年和3年通畅率均为100.0%,未出现周围神经损伤、围手术期死亡、卒中等。结论一站式颈动脉内膜剥脱术联合椎动脉转位术能同期处理同侧颈动脉狭窄和椎动脉狭窄病变,改善脑部血供,改善患者症状,具有较高的推广价值。

Objective To explore the treatment outcome of carotid endarterectomy combined with vertebral artery transposition in patients with severe stenosis to occlusion of the vertebral artery V1 segment and the ipsilateral carotid artery.Methods From June 2017 to September 2020,patients with severe stenosis to occlusion of the vertebral artery V1 segment and the ipsilateral carotid artery treated with carotid endarterectomy combined with vertebral artery transposition in Fuwai Hospital were retrospectively analyzed.Results Finally 12 patients were enrolled,including 10 males and 2 females with an average age of 67.8±6.0 years.Twelve patients were successfully operated and the follow-up time was 1-3 years.The stenosis degree of the V1 segment of the vertebral artery decreased from 83.5%±11.8%to 24.9%±14.3%(P<0.001).The stenosis degree of carotid artery decreased from 85.6%±11.0%to 0%(P<0.001).Postoperative follow-up showed that the symptoms of symptomatic patients before surgery improved.The 1-year and 3-year patency rates were 100.0%,and there were no peripheral nerve injury complications,perioperative deaths or strokes.Conclusion Carotid endarterectomy combined with vertebral artery transposition can treat ipsilateral carotid artery stenosis and vertebral artery stenosis at the same time,improve blood supply to the brain,improve patients'symptoms and has high promotion value.