颈动脉内膜切除术治疗颈动脉狭窄46例临床分析

Clinical Analysis of Carotid Endarterectomy in Treatment of 46 Patients with Carotid Stenosis

目的讨论颈动脉内膜切除术(CEA)的适应证及疗效。方法山东大学附属省立医院血管外科2009年6月—2013年12月采用CEA治疗颈动脉狭窄46例,男29例,女17例;平均年龄67.2岁;平均病程4.1年;病变部位:左侧19例,右侧18例,双侧9例。均有不同程度脑缺血表现。结果 46例手术均成功,平均手术时间90 min,术中颈动脉平均阻断时间14 min。应用颈动脉补片23例,应用颈动脉转流管22例。2例术后因内膜撕脱形成夹层,行颈动脉支架置入术。3例术后发生脑梗死,予对症治疗后康复出院,无后遗症。术后均获随访,平均随访时间21个月。术后12个月行超声检查发现手术侧颈动脉再狭窄2例,狭窄程度均<60%,无临床症状,未行处理。结论 CEA简单经济,作为治疗颈动脉狭窄、预防脑卒中的方法效果肯定。

Objective To investigate the indications and effect of carotid endarterectomy （ CEA） . Methods A total of 46 patients with carotid stenosis undergoing CEA in vascular surgery department of Shandong Provincial Hospital during January 2009 and December 2013 were enrolled in this study. There were 29 males and 17 females;the mean age was 67. 2 years old;the mean course of disease was 4. 1 years;carotid lesions located on left-side in 19 cases, on right-side in 18 cases and bilateral in 9 cases. All the patients had brain ischemia in different degrees. Results CEA was suc-cessfully performed in 46 patients with a mean operation time of 90 min and a mean carotid blocking time of 14 min. Ca-rotid patch was applied in 23 cases, and carotid shunt was used in 22 cases. Carotid stent implantation was performed in 2 cases because of mezzanine induced by postoperative carotid intima avulsion. Three patients had postoperative cerebral infarction, and were discharged after rehabilitation without sequelae by symptomatic treatment. All the patients were fol-lowed up for a mean period of 21 months. Carotid stenosis （ stenosis degree 〈60%） was observed with ultrasonography in 2 cases 12 months after operations without any symptoms or treatment. Conclusion Carotid endarterectomy is a cheap, simple and effective method to prevent carotid artery stenosis and cerebral apoplexy.