颈动脉内膜剥脱术治疗颈动脉狭窄(附40例临床分析)

Clinical Analysis of 40 Cases of Carotid Stenosis Treated with Carotid Endarterectomy

目的总结应用颈动脉内膜剥脱术（carotid endarterectomy,CEA）治疗颈动脉粥样硬化狭窄的经验,评价CEA疗效。方法回顾性分析我院40例应用CEA治疗颈动脉粥样硬化狭窄患者的临床资料,共进行40例41侧。所有研究对象中,单侧颈动脉狭窄17例,其中中度狭窄（50%~69%）1例,重度狭窄（70%~99%）16例;双侧颈动脉狭窄23例,其中术侧中度狭窄3例,重度狭窄21例,手术对侧完全闭塞患者4例;左侧18例,右侧23例。既往有脑梗死病史患者19例,遗留神经功能障碍8例;既往反复TIA发作患者35例。患者合并高血压（Ⅰ~Ⅱ级）7例,高血压（Ⅲ级）29例,冠心病11例,糖尿病11例。结果所有研究对象术后恢复良好,围手术期内无严重并发症及死亡事件,仅1例术后出现分水岭梗塞。术后随访3~12个月,1例出现再狭窄。结论 CEA治疗颈动脉硬化狭窄疗效可靠,术前合理评估病情及围手术期的正确处理对减少术后并发症非常重要。

Objective To summarize the experiences in the treatment of carotid atherosclerosis stenosis with carotid endarterectomy. Methods The clinical data of 40 cases of carotid atherosclerosis stenosis in our hospital were retrospectively analyzed, and 41 sides（ 1 case were bilateral） were treated by carotid endarterecto- my. There were unilateral carotid artery stenosis in 17 eases, including 1 case of moderate stenosis （50% ～69% ）, and 16 eases of severe stenosis （70% ～99% ）. There were bilateral carotid artery stenosis in 23 cases, in- eluding 3 cases of moderate stenosis in the operative side, 21 eases of severe stenosis in the operative side, and 4 ea- ses of complete occlusion in the contralateral carotid artery. The stenosis side was 18 of left, and 23 of right. There were 19 patients with cerebral infarction, 8 patients with neurological dysfunction, and 35 patients with recturrent TIA attacks. Results All the eases recovered well, and there were no serious complications or deaths during the peri- operative period. The patients were followed up for 3 - 12 months, and 1 ease had restenosis. Conclusion Cura- tive effect of CEA for treating carotid atherosclerosis stenosis is reliable. It is very important to evaluate the illness reasonably and handle the problems correctly in the perioperative period for reducing the postoperative complications.