颈动脉狭窄的外科治疗

Carotid endarterectomy, clinical analysis of 43 cases

目的 探讨颈动脉内膜剥脱术中的外科技术要点。方法 在颈丛麻醉下 ,对 4 3例颈动脉狭窄患者行颈动脉内膜剥脱术 ,其中有 2例是在颈总动脉和颈内动脉之间建立分流后 ,再行颈动脉内膜剥脱术。结果 颈动脉平均阻断时间为 2 7min± 7min ,术后 1例出现一过性神志欠佳 ,11例出现高血压 ,2例出现伤口轻度肿胀 ,后均康复出院。 2 6例术前有症状患者 ,术后症状明显改善 ,术后随访均稳定。结论 颈丛麻醉可以了解患者脑部供血情况 ,对于阻断颈总动脉脑缺血者 ,采用自颈总动脉至颈内动脉建立分流 ,可以避免出现缺血性脑损伤。手术效果主要取决于术中操作、完整去除颈动脉内膜残片及碎屑。

Objective To evaluate the important points in carotid endarterectomy. Methods Carotid endarterectomy was performed upon 43 cases of carotid artery stenosis under cervical plexus anaesthesia. The operation was performed with shunting between the common carotid artery and the internal carotid artery in 2 cases. Results The average clamping time of carotid artery was 27 min±7 min. There were one case suffering from transiebnt ischemic attack (TIA), 7 cases suffering from hypertension and 2 cases suffering from light edema of the wound. All of the patients recovered uneventfully. Twenty six patients who had suffered from TIA before operation felt much better after operation. The follow up of one month to one year showed a better condition among all patients. Conclusion Cervial plexus anaesthesia helps diagnose stroke during operatrion. Shunting between the common carotid artery and internal carotid artery helps avoid ischemic brain injury. The effect of operation depends upon complete removal of the residual tunica intima, complete exsufflation, and control of hypertension postoperationally.