双侧分期颈动脉内膜切除术33例临床分析

The clinical evaluation of staged bilateral carotid endarterectomy

目的对双侧颈动脉重度粥样硬化性狭窄患者分期接受双侧颈动脉内膜切除术以预防和治疗缺血性脑卒中的临床疗效进行评价，浅析双侧颈动脉重度狭窄的手术策略。方法回顾性分析2009年3月至2013年3月大连市中心医院收治的双侧颈动脉重度狭窄患者33例，狭窄程度均为70％-99％。对所有患者分期行双侧颈动脉内膜切除术，手术均采用全麻，所有病例术中均未采用转流管，其中标准式颈动脉内膜切除术（sCEA）13例26次，外翻式颈动脉内膜切除术（eCEA）20例40次，两期手术时间间隔为0．5-10个月，平均为1．5个月。结果所有手术术中操作顺利，所有患者术后脑缺血症状明显改善，所有患者围手术期内均未出现死亡及脑卒中事件，并且在术后1-36个月的随访中均未出现脑卒中及其他严重并发症，且患者的生活质量有明显改善。结论分期行双侧颈动脉内膜切除术对双侧颈动脉重度狭窄患者预防和治疗缺血性脑卒中是安全有效的，两期手术间隔时间与患者预后无明显相关性。

Objective To evaluate the clinical efficacy and strategy of staged bilateral carotid endarterectomy（SBCEA） for patients with bilateral severe carotid atherosclerotic stenosis. Methods 33 patients with bilateral carotid atherosclerotic severe stenosis （70% -99% ） were admitted to our hospital from March 2009 to March 2013. The patients all were diagnosed carotid atherosclerotic stenosis according to clinical manifestations, carotid CDFI, TCD, carotid and brain DSA/CTA/MRA. All of patients underwent staged bilateral CEA by general anesthesia without intraoperative shut, therein 13 of them by sCEA and the others by eCEA. The time interval between two stages was from 0. 5 to 10 months, and the average was 1.5 months. Results The clinical manifestations were all improved after operation, and there was no mortality and stroke complications postoperatively. All of the patients were followed-up for 1 - 36 months after surgery, no stroke or other severe complications were found and the quality of life was improved. Conclusions It is safe and effective that patients with bilateral severe carotid atherosclerotic stenosis undergo staged bilateral carotid endarterectomy. There is no significant difference in prognosis, even though the time interval between two sta^es has no influence on outome.