手术治疗症状型颈总动脉迂曲的疗效评价

EFFECTIVENESS OF SURGICAL TREATMENT OF SYMPTOMATIC TORTUOSITY COMMON CAROTID ARTERY

目的 探讨症状型颈总动脉迂曲（symptomatic tortuosity common carotid artery,SCAT）行血管重建术治疗的安全性和有效性。方法 回顾性分析2010年6月-2013年10月采用血管重建术治疗的12例SCAT患者临床资料,其中男1例,女11例;年龄48～62岁,平均54.8岁。均为右侧患病。影像学检查显示迂曲的颈总动脉均呈C形,长度4～8 cm,平均5.4 cm。术后1、3、6、9、12个月及之后每年随访1次,行头颅CT、血管超声、CT血管造影术或动脉造影检查。结果 手术成功率100%。手术时间平均1.98 h,术中出血量平均50 mL,颈总动脉阻断时间平均14.9 min。术中动脉造影均显示血管通畅无狭窄,跨迂曲段收缩压压差由术前（39.58±9.54）mm Hg（1 mm Hg=0.133 kPa）下降为术后即刻（5.50±2.39）mm Hg,差异有统计学意义（t=15.492,P=0.000）。围手术期未出现手术相关并发症和死亡,术后无周围神经系统改变、颈动脉闭塞。12例均获随访,随访时间9个月～3年。患者血管无复发或狭窄。末次随访时,患者收缩压及舒张压分别为（132.17±6.24）、（82.67±6.51）mm Hg,均较术前（152.83±14.80）、（94.17±11.30）mm Hg明显改善（t=5.751,P=0.000;t=4.976,P=0.000）。结论 血管重建术治疗SCAT早、中期疗效较好,术后并发症和死亡发生率低,远期结果尚待进一步随访。

Objective To investigate the safety and effectiveness of vascular reconstruction in patients with symptomatic tortuosity common carotid artery （SCAT）. Methods A retrospective analysis was made on the clinical data of 12 cases of SCAT treated with vascular reconstruction between June 2010 and October 2013. There were 11 females and 1 male with the mean age of 54.8 years （range, 48-62 years）. The unilateral common carotid artery was involved in all cases. Imaging examination showed C-shaped tortuosity of 4-8 cm in length （mean, 5.4 cm）. The CT, brain CT, ultrasound examinations, or angiography was performed at 1, 3, 6, 9, and 12 months, and annually. Results The surgery success rate was 100% with no perioperative death and serious complications. The mean operation time was 1.98 hours; the mean blood loss was 50 mL; and the mean clamping time was 14.9 minutes. The systolic pressure gradient across the lesion was significantly decreased from （39.58＋±9.54） mm Hg （1 mm Hg=0.133 kPa） at pre-operation to （5.50±2.39） mm Hg at immediate after operation （t=15.492, P=0.000）. No recurrence or stenosis was found at 9 months to 3 years of follow- up. The systolic and diastolic pressures at last follow-up were significantly improved to （132.17±6.24） mm Hg and （82.67±6.51） mm Hg from （152.83±14.80） mm Hg and （94.17±11.30） mm Hg at pre-operation （t=5.751, P=0.000; t=4.976, P=0.000）. Conclusion Vascular reconstruction in SCAT is recommended for good short- and mid-term effectiveness and relatively low complication and mortality after operation. Moreover, the long-term results still need to be investigated.