颈动脉狭窄合并糖尿病患者行颈动脉内膜剥脱术的疗效分析

Effectiveness analysis of carotid endarterectomy in diabetic patients suffering from carotid stenosis

目的评价颈动脉狭窄合并糖尿病患者接受颈动脉内膜剥脱术（CEA）的围手术期风险及疗效。方法回顾性分析2010年12月至2013年12月行CEA治疗的148例颈动脉狭窄患者的临床资料；按是否伴发糖尿病分为糖尿病组（n=83）和非糖尿病组（n=65）；比较2组病例的年龄、性别、危险因素、术中情况、术后并发症、1年后再狭窄率。结果2组患者的一般资料、临床症状、伴随疾病、手术时间、出血量、术中转流等差异均无统计学意义（均P〉0．05）。糖尿病组术后感染、颈部血肿、颅神经损伤、心肌梗死、术后脑梗死、高灌注综合征、全因死亡发生率及1年后再狭窄率分别为7．2％、12．0％、10．8％、3．6％、6．0％、9．6％、2．4％、9．6％，非糖尿病组分别为3．1％、9．2％、4．6％、1．5％、4．6％、7．7％、1．5％、3．1％，差异均无统计学意义（χ2=0．551、0．300、1．898、0．069、0、0．172、0．138、1．559，均P〉0．05）。结论颈动脉狭窄合并糖尿病的患者在严格控制血糖、术前充分评估心脑血管状况并提前干预情况下，可以接受CEA手术。

Objective To evaluate the perioperative complications and effectiveness of carotid endarterectomy （CEA） with diabetes mellitus （DM）. Methods A total of 148 patients with carotid stenosis undergone CEA from December 2010 to December 2013 were collected and analyzed retrospectively. The patients were distributed into DM group （ n = 83 ） and the control group （ n = 65 ） according to the comorbidities. Age, gender, risk factors, stenosis degree, cerebral ischemie symptom, shunt in operation, perioperative complications and restenosis after one year in the two groups were analyzed and compared . Results There were no statistical difference between the two groups in terms of the general characteristic, clinical iscbemic symptoms, concomitant disease, operative time, the amount of bleeding, the ratio of shunt （P 〉 0. 05 ）. The rates of perioperative complications observed in DM group, including postoperative infection, neck hematoma, cranial nerves injured, acute cardiac infarction, stroke, hyperperfusion syndrome, all-cause mortality and one year restenosis after operation were 7. 2%, 12. 0%, 10. 8% ,3.6%, 6. 0% ,9. 6% ,2.4% and 9. 6% respectively. The complication rates observed in the control group, on the other hand were 3.1% ,9. 2% ,4. 6% ,1.5% ,4. 6% ,7. 7% ,1.5% and 3.1% respectively. There were no significant statistical difference between the two groups （χ2 = 0. 551, 0. 300, 1. 898, 0. 069, 0, 0. 172, 0. 138, 1. 559 ,P 〉 0. 05）. Conclusion CEA may be safe and effective in diabetic patients suffering from carotid stenosis, on the condition that the blood glucoses of the patients are controlled well, and the cardio cerebral vascular system is carefully assessed and intervened before the operation.