对侧颈动脉闭塞对颈动脉内膜切除术围手术期疗效的影响

Effect of contralateral carotid occlusion on perioperative efficacy of carotid endarterectomy

目的探讨对侧颈动脉闭塞对颈动脉内膜切除术(CEA)围手术期疗效的影响。方法回顾性分析2000年1月—2011年9月共296例于首都医科大学宣武医院因颈动脉狭窄行一侧CEA术患者的临床资料。根据是否伴有对侧颈动脉闭塞分为对侧闭塞组17例,对侧未闭塞组279例。分析两组术中应用转流管情况及术后30 d内的疗效。结果①对侧闭塞组术中转流管应用率为47.1%(8/17),高于对侧未闭塞组的18.3%(51/279),差异有统计学意义,P=0.010。②对侧闭塞组应用转流管的8例患者中,前交通动脉开放的有4例(4/8),未用转流管的9例中,前交通动脉开放的有2例(2/9),P=0.335。对侧闭塞组应用转流管的患者中,后交通动脉开放的有3例(3/8),未用转流管者中后交通动脉开放的有9例(9/9),差异有统计学意义,P=0.009。③279例对侧未闭塞组中,术后30 d卒中的发生率为3.2%(9/279),病死率为1.4%(4/279),脑神经损伤、心脏并发症的发生率均为3.6%(10/279);对侧闭塞组除2例(11.8%)发生心脏并发症外,无其他并发症发生,但两组并发症及病死率的比较,差异均无统计学意义。结论伴有对侧颈动脉闭塞的患者,在CEA术中会增加转流管应用的比例,尤其是后交通动脉未开放的患者,但并不增加围手术期并发症及死亡的风险。

Objective To investigate the effect of contralateral carotid occlusion on perioperative efficacy of carotid endarterectomy（CEA）.Methods The clinical data of 296 patients with carotid stenosis performed unilateral CEA in Xuanwu Hospital from January 2000 to September 2011 were analyzed retrospectively.They were divided into either a contralateral occlusion group（n=17） or a non-occlusion group（n=279） according to whether they had contralateral carotid occlusion or not.The intraoperative shunting application and the efficacy within 30 days after surgery in both groups were analyzed.Results ①The intraoperative shunting application rate in the contralateral occlusion group was 47.1%（8/17）,and it was higher than 18.3%（51/279） in the non-contralateral occlusion group（P=0.010）.②Among the 8 patients who used shunting in the contralateral occlusion group,4（4/8） had anterior communicating artery patent;among the 9 patients without using shunting,2（2/9） had anterior communicating artery patent（P=0.335）.Among the patients who used shunting,3（3/8） had posterior communicating artery patent,and among the patients who did not use shunting,9（9/9） had posterior communicating artery patent（P=0.009）.③Of the 279 patients in the contralateral non-occlusion group,the postoperative stroke rate at day 30 was 3.2%（9/279）;the mortality was 1.4%（4/279）.Brain nerve damage and cardiac complications were 3.6%（10/279） respectively;in addition to 2（11.8%） had cardiac complications,no other complications occurred in the contralateral occlusion group,but there were no significant differences in complications and mortality in both groups.Conclusion In patients complicating with contralateral carotid occlusion,CEA may increase the rate of shunting application,especially in patients with patent posterior communicating artery,however,it does not increase the risks of perioperative complications and mortality.