标准式与外翻式颈动脉内膜切除术治疗颈动脉狭窄

Application analysis between standard and eversion carotid endarterectomy in the treatment of carotid artery

目的探讨标准式与外翻式颈动脉内膜切除术治疗颈动脉狭窄的临床应用。方法总结颈动脉内膜切除术治疗颈动脉粥样硬化狭窄81例患者的临床资料，共90侧，标准术式25侧，外翻术式65侧，分析两种术式的特点，评价其应用价值及疗效。结果手术均获成功，动脉阻断时间为：标准式为13．4—48．2min，外翻式为14．5—31．2min。术后患者均复查颅颈CTA，必要时复查颅脑CT，显示手术侧颈动脉形态正常。采用标准式中2例2侧术后出现术侧脑梗死灶，另有2例2侧术后11个月出现吻合口区域粥样斑块形成、再狭窄；外翻式中1例1侧术后14个月出现再狭窄；8例8侧颈内动脉狭窄伴扭曲者采用外翻式后扭曲消失。结论标准式及外翻式颈动脉内膜切除术可以有效地治疗颈动脉狭窄，预防脑卒中。两种手术方式各有特点，应根据手术者的习惯、熟练程度以及患者病变、影像、解剖特点等选择合适的手术方式。

Objective To evaluate the standard and eversion carotid endarterectomy for carotid artery stenosis in clinical application. Methods We analyzed clinical data of 90 sides with 81 patients with carotid endarterectomy, the standard type 25 sides, eversion type 65 sides, analyzing the characteristics of two procedures to assess the value and efficacy of its applications. Results all operations were successful, block time ： standard - type 13.4 - 48.6 rain, eversion - type 14. 5 - 31.2 min. Postoperative patients were reviewed craniocervical CTA, if necessary, review head CT, carotid artery operated side showed normal morphology, the two cases used the standard type occurred after surgery side of infarct, and two cases occurred anastomotic regional plaque formation and restenosis after 11 months ; 8 cases of internal carotid artery stenosis and those with hallux valgus bending distortion disappears rear. Conclusions To Standard and eversion carotid endarterectomy can effectively treat carotid artery stenosis to prevent stroke. Two surgical methods have their own characteristics. The appropriate surgical approach should be based on proficiency and patients with lesions, imaging, anatomical.