颈动脉内膜剥脱术治疗颈动脉狭窄35例临床分析

Application of carotid endarterectomy to treat carotid atherosclerotic stenosis：a clinical analysis of 35 cases

目的：总结颈动脉内膜剥脱术（ CEA）治疗颈动脉狭窄手术技巧及围手术期管理方法。方法回顾性分析35例CEA手术治疗的颈动脉狭窄患者的临床资料，探讨术前准备、术中操作技巧、术后并发症预防。结果35例手术过程顺利。1例术后术侧新发脑梗死，偏瘫加重，治疗后好转。舌下神经瘫1例。轻度过度灌注综合征5例。无切口感染、切口血肿病例。35例患者出院前均复查颈部CT血管造影（ CTA），显示术侧颈内动脉起始处通畅、无狭窄。随访1-18个月，无新发脑梗死病例，术前短暂性脑缺血发作（ TIA ）患者术后发作明显减少或消失。结论 CEA是治疗颈动脉狭窄的有效方法。严格把握手术适应证、完善手术技巧及围手术期管理可减少术后并发症。

Objective To summarize the surgical techniques used in carotid endarterectomy （ CEA） for treatment of carotid atherosclerotic stenosis and approaches to perioperative management.Methods Clinical data were collected from 35 patients who underwent CEA due to carotid atherosclerotic stenosis and retrospectively analyzed, in order to discuss preoperative preparation, intraoperative surgical techniques, and prevention and treatment of postoperative complications. Results All operations were finished smoothly in all patients.One patient developed new cerebral infarction at the surgi-cal side after operation and aggravated hemiparesis, which were relieved after consequent treatments.Another patient manifested paralysis of the hypoglossal nerve.Five patients presented mild cerebral hyperperfusion syndrome.No incision infection and hematoma was reported.All patients were re -examined with neck CT angiography （ CTA ） before dis-charge, which showed smoothness at the starting point of the carotid artery at the treated side.Follow-up visits lasted for 1-18 months.No cerebral ischemia was reported.Patients with preoperative transient ischemic attack （ TIA） presented obviously relieved symptoms or did not present symptoms after operation.Conclusion CEA is an effective approach to treat carotid atherosclerotic stenosis.It is crucial to strictly follow the proposed inclusion criterion, refine surgical tech-niques and perioperative management to reduce complications.