颈动脉内膜切除术治疗症状性颈动脉狭窄40例总结

The application of carotid endarterectomy in symptomatic carotid artery stenosis:a report of 40 cases

目的探讨应用颈动脉内膜切除术(CEA)治疗症状性颈动脉狭窄的早期疗效和体会。方法 40例症状性颈动脉狭窄行CEA手术的患者纳入本研究。所有病例均具有脑缺血的临床症状。全组均经颈部彩色多普勒成像、经颅多普勒超声初期筛查检出,9例、3例、28例分别应用增强磁共振血管成像、CT血管造影、数字减影血管造影确诊为颈动脉粥样斑块形成并颈动脉狭窄。40例颅外段颈动脉狭窄程度均≥70%,其中合并溃疡病变5例,一侧颈内动脉狭窄伴另一侧颈内动脉完全闭塞1例。患者全部行全身麻醉联合颈丛神经阻滞麻醉。术中全部放置动脉临时分流管,行颈动脉血管补片成形术32例。结果全组围手术期无死亡病例,脑缺血症状明显改善31例(77.5%),症状好转9例(22.5%)。术后并发高灌注综合征1例,血流动力学不稳定1例。症状性颈动脉狭窄围手术期并发症5.0%(符合美国AHA≤6%的标准)。40例均获随访,在术后6周及3个月复查双侧颈部血管超声,无1例血管再狭窄发生。结论 CEA是治疗症状性颈动脉狭窄安全且有效的方法。

Objective To summarize the short-term efficacy and applied experience of carotid endarterectomy（CEA） in symptomatic carotid artery stenosis.Methods A total of 40 patients with symptomatic carotid artery stenosis to receive CEA were recruited in this study.All the patients had clinical symptoms of cerebral ischemia.The carotid atheromatous plaque and carotid stenosis were first screened by carotid Doppler ultrasonography and transcranial Doppler （TCD）, then conformed respectively through enhanced magnetic resonance angiography （CE-MRA）,CT angiography （CTA）,digital subtraction angiography （DSA）.The degrees of carotid artery stenosis of extracranial segment were all equal to or more than 70%.In them,5 cases combined ulcer lesion,and 1 case combined one-lateral internal carotid stenosis and another lateral internal carotid complete occlusion.CEA operation was carried out under general anesthesia using endotracheal intubation combined cervical plexus block.Carotid temporal shunting tube was used in all cases.Patch angioplasty was performed in 32 cases.Results No perioperative deaths happened.Thirty-one cases had significant improvement of ischemic cerebral symptom,and 9 cases had certain improved.Postoperative hyper-perfusion syndrome and hemodynamic instability happened separately in 1 case.The complications of perioperative period of symptomatic carotid artery stenosis were 5.0% consistent with the standard of American Heart Association （AHA） equal to or less than 6%.All cases were followed up.No vascular restenosis happened during re-examination of double lateral cervical vascular ultrasonography at 6 weeks and 3 months after operation.Conclusions CEA is a safe and effective treatment method for symptomatic carotid artery stenosis.