颈动脉内膜剥脱术相关临床问题的探讨

Carotid endarterectomy and some related clinical problems

目的:探讨颈动脉内膜剥脱术治疗颈动脉硬化狭窄的临床疗效并讨论与之相关的几个有争议的问题。方法:回顾性分析2000年10月至2007年10月间,72例因颈动脉狭窄而行颈动脉内膜剥脱术的患者资料。结果:全组无手术死亡。72例患者手术后均恢复良好,无严重并发症发生。随访的63例中,61例患者术前临床症状均有不同程度改善,观察期内无短暂性脑缺血发作。5例在颈动脉内膜剥脱术同期行冠状动脉搭桥术,疗效满意;4例颈动脉完全闭塞患者,手术后2例颈动脉血流再通。部分患者选择性应用术中转流技术,效果良好。结论:颈动脉内膜剥脱术是治疗颈动脉硬化安全、有效的手术方式,术中可选择性应用转流技术;对合并冠心病的颈动脉狭窄,主张同期联合手术;部分颈动脉完全闭塞者仍有手术重建血流的可能。

Objective：To investigate the effect of carotid endarterectomy （CEA） on carotid artery stenosis and discuss some controversial issues related to it. Method：The clinical records of 72 patients undergoing CEA for carotid artery stenosis from Oct. 2000 to Oct. 2007 were reviewed retrospectively. Result： No surgical deaths occurred. All the 72 patients recovered well after the operation without serious complications. Among the 63 followed up patients, 61 cases improved the clinical complaints in different degrees compared with that before operation, and no transient ischemic attack observed during the period of follow-up. A simultaneous coronary artery bypass grafting （CABG） and CEA was successfully performed in 5 patients suffered coexistent cerebral and coronary vascular disease with a good outcome. In the 4 patients with occluded carotid artery underwent direct CEA on the diseased vessels, there were 2 cases achieved revascularization. Intraluminal shunting technique was selectively used in some patients with a good achievement. Conclusion： CEA appears to be a safe and effective procedure in the management of carotid artery stenosis, and the selective use of intraluminal shunting during the operation seems feasible. Combined procedure of CEA and CABG for patients with concomitant carotid and coronary artery disease was justified in this study. Some of the patients with a documented carotid artery occlusion still have the chance to he revaseularized by direct CEA upon the affected vessels.