颈动脉切除术的体会

Experience of Carotid Resection

目的:探讨颈动脉切除术的安全检测指标,确保手术成功和患者生命安全。方法:19例行颈动脉切除的肿瘤患者采用术前体外或体内颈动脉压迫训练法,阻断颈动脉血流,通过经颅多普勒(TCD)和数字减影(DSA)检测了解脑侧支循环建立及交通动脉开放情况。术中夹闭颈总动脉,TCD检测患侧大脑前动脉(ACA)和大脑中动脉(MCA)代偿情况。结果:体外压迫训练18～45d,体内压迫训练7～9d达到合格标准。18例肿瘤全切,1例肿瘤包绕椎动脉入颅处行部分切除。无死亡病例和术后脑缺血及偏瘫等严重并发症。16例随访1～5a无复发。结论:缓慢渐进的颈动脉压迫训练是促进脑侧支循环建立和患侧脑血流代偿的有效方法。TCD和DSA检测对手术成功和保障患者生命安全起决定性作用。

Objective：To investigate the reliable index in the cervical axteriectomy in order to ensure the opelation success and patients＇ life security.Methods：To interdict the blood flow of carotid by extra- corporeal and intra- corporeal carotid pressure training before operation. Then to examine the collateral circulation and communicating artery by Trans- cranial Doppler（TCD）and Digital Subtraction Angiography（DSA）. To interdict the arteria carotis during the operation and examine the compensation of anterior cerebral artery（ACA）and middle cerebral artery（MCA） in involved side.Results：All patients accepted carotid training, extra- corporeal carotid pressure training in 13 cases for 18-45 days and intra- corporeal carotid pressure training in 7 cases for 7-9 days.No the symptoms of cerebral ischemia were found in all patients after interdicting the carotid blood flow within 30 - 40 minutes continuously. The tumors were entirely resectnd except for 1 case whose tumor fixed to vertebral artery near skull base. No death and severe complications were found. Conclusions： The gradual carotid pressure training is an effective method to promote collateral circulation and compensation in the involved side. The detection of TCD and DSA are important to ensure the operation success and patients＇ life security.