颈动脉内膜剥脱术治疗双侧颈动脉中重度狭窄59例

Carotid endarterectomy for bilateral moderate to severe carotid stenosis： report of 59 cases

目的总结颈动脉内膜剥脱术（carotidendarterectomy，CEA）治疗双侧颈动脉中、重度狭窄的临床经验。方法回顾性分析2010年10月至2014年8月中日友好医院收治的59例双侧颈动脉中、重度狭窄患者的临床资料，其中男50例，女9例，年龄42～80岁，平均（65±9）岁。48例施行单侧CEA，11例双侧先后施行CEA。术前造影证实合并冠心病或周围血管疾病的患者6例同期行冠状动脉旁路移植术，1例同期行髂动脉球囊扩张及支架植入术，1例同期行肾动脉支架植入术。结果59例患者共施行70次CEA，均使用转流管及血管补片，手术成功率100％。2例迷走神经损伤，4例舌下神经损伤，3例出现过度灌注综合征。术后随访2～36个月，平均（19±10）个月。随访期间1例因心脏病发作死亡。其余患者病情稳定，均未发现再狭窄。结论对于双侧颈动脉中、重度狭窄患者，只要手术指征明确，均应施行CEA。

Objective To evaluate carotid endarterectomy （CEA） for bilateral moderate to severe carotid stenosis. Methods The clinical data of 59 patients with bilateral moderate to severe carotid stenosis who were treated with CEA in our hospital from October 2010 to August 2014 were retrospeetively analyzed. There were 50 males and 9 females age ranging 42 - 80 years （ mean ： 65±9 years）. 48 patients underwent ipsilateral CEA and 11 underwent staged bilateral CEA. In patients who were confirmed to have coronary artery disease or peripheral vascular disease by preoperative angiography ,6 received coronary artery bypass graft （CABG） simultaneously, 1 received iliac artery balloon angioplasty and stent implantation simultaneously, and 1 received renal artery stenting simultaneously. Results A total of 70 endarterectomies were performed, shunt and patching were used in all patients, the surgical success rate was 100%. 2 patients suffered from vagus nerve injury ,4 patients suffered from hypoglossal nerve injury, and 3 patients presented with hyperperfusion syndrome. Follow-up period was 2 -36 months （mean： 19± 10 months）. 1 patient died of heart attack during the follow-up,the other patients were relatively stable with no restenosis. Conclusion CEA should be performed in patients with bilateral moderate to severe carotid stenosis, and the prognosis is good.