外翻式颈动脉内膜切除术治疗颈动脉颅外段狭窄的疗效观察

Observation on the effect of eversion carotid endarterectomy for extracranial carotid artery stenosis

目的观察外翻式颈动脉内膜切除术（eCEA）治疗颈动脉颅外段狭窄的临床疗效。方法选择狭窄率≥50％的有症状性颈动脉粥样硬化性狭窄患者23例，采用eCEA术式行颈动脉内膜切除术，其中4例颈内动脉合并颈总动脉狭窄患者采用内膜切除器，行eCEA＋逆行性颈总动脉内膜切除术。所有患者均获得6个月临床及颈动脉超声、CT血管成像随访。结果23例患者斑块均被成功切除，术中无严重并发症。2例患者术后出现明显气管移位，7例术后出现声音嘶哑，均在术后3个月内恢复。4例患者术后72h内有短暂性脑缺血（TIA）发作，头部CT检查无梗死灶出现，经小剂量尿激酶治疗后恢复正常。无严重脑水肿、脑出血患者。术后随访6个月，13例因TIA发作入院的患者未再出现症状，其他原有临床症状均有不同程度的好转。复查颈动脉超声和CT血管成像，显示无一例患者出现颈动脉再次狭窄。结论eCEA治疗颈动脉颅外段狭窄安全、有效，短期疗效较好。

Objective To observe the clinical efficacy of eversion carotid endarterectomy （eCEA） in the treatment of extracranial carotid artery stenosis. Methods Twenty-three patients with symptomatic carotid atherosclerotic stenosis （ ≥50% ） were included. Eversion carotid endarterectomy was performed for the patients. Among them, eCEA ＋ retrograde common carotid endarterectomy were performed by using a ring striper in 4 patients with internal carotid artery stenosis complicated with common carotid artery stenosis. All patients were followed up for 6 months about their clinical condition and the carotid ultrasonographic and computed tomography angiographic results（CTA）. Results All the carotid plaques of the 23 patients were removed successfully. There was no serious complications during the operation. Two patients experienced significant tracheal displacement, 7 patients experienced hoarseness after the procedure, and they all recovered within 3 months after the surgery. Four patients experienced TIA within 72 hours after the operation, no cerebral infarction was detected by CT scan, and they recovered to normal after low-dose urokinase treatment. There were no severe brain edema and cerebral hemorrhage occurred after the procedures. After postoperative follow-up for 6 months, the symptoms in 13 patients with TIA did not reoccurred, and the other original clinical symptoms were improved. Carotid ultrasonography and CTA reexaminations revealed that no restenosis occurred. Conclusion eCEA is safe and effective in the treatment of extracranial carotid artery stenosis, and the short-term efficacy is proves good.