显微镜下颈动脉内膜剥脱术临床并发症分析

Clinical analysis of carotid endarterectomy under Microscope

目的分析颈动脉内膜剥脱术后并发症的原因并探讨其防治措施。方法回顾性分析99例因严重颈动脉狭窄(狭窄率70%~99%)而行颈动脉内膜剥脱术104侧的临床资料。结果术后颈动脉血栓形成至缺血性卒中1例,颈内动脉夹层至缺血性卒中2例,死亡2例(1例为77岁老年患者,术后次日发生急性心肌梗死,术后1个月死亡;另1例缺血性卒中并发上消化道出血死亡),脑过度灌注综合征3例,术区血肿形成1例。结论术前评估、术中操作及判断不当、严重高血压是导致术后并发症的主要因素。高度重视术前评估,手术中常规应用脑电图监测、必要时应用临时转流管,严格控制血压,术中、术后严密监护等,有利于减少术后并发症的发生。

Objective To analyze the causes of postoperative complications of carotid endarterectomy and discuss the prevention and treatment. Methods Retrospective analysis of 99 cases of carotid endarterectomy due to severe carotid stenosis （stenosis rate of 70% - 99%） 104 cases of the clinical data. Results After carotid artery thrombosis to ischemic stroke in i case, internal carotid artery dissection to ischemic stroke in 2 cases, 2 deaths （1 case of 77 years old patients, the day after the occurrence of acute myocardial infarction, postoperative 1 case of death; the other 1 case of ischemic stroke complicated with upper gastrointestinal bleeding death）, cerebral hyperperfusion syndrome in 3 cases, 1 case of hematoma formation. Cone I us i on Preoperative evaluation, intraoperative operation and improper judgment, severe hypertension is the main factor leading to postoperative complications. It is necessary to use temporary transfer tubes, strict control of blood pressure, intraoperative and postoperative intensive care and so on, which is helpful to reduce the incidence of postoperative complications.