一侧颈内动脉闭塞患者内膜剥脱术中不使用转流管的安全性分析

Safety analysis of carotid endarterectomy without shunting in carotid artery stenosis patients with contralateral carotid occlusion

目的探讨在电生理监测下，使用颈动脉内膜剥脱术（CEA）治疗颈内动脉重度狭窄伴（CAS）对侧颈内动脉闭塞（CAO）患者且术中不使用转流管的安全性。方法回顾性分析首都医科大学附属天坛医院于2013至2016年间收治的71例颈动脉狭窄患者的临床资料，将71例患者分为两组，A组20例为手术侧狭窄伴对侧颈内动脉闭塞患者；B组51例为双侧颈内动脉狭窄患者。随访CEA术后30d及术后6个月内患者术侧新发脑梗、新发脑出血及心脏等并发症发病率及死亡率，以此评价伴对侧颈内动脉闭塞患者CEA术中不使用转流管的安全性。结果7l例患者均在电生理监测下顺利完成手术，术中均未使用转流管。术后30d随访，A组20例患者中无心脏并发症，无新发脑梗患者，1例（5．00％）新发脑出血病例，无死亡病例，无其他不良事件发生；B组51例患者中无心脏并发症，无新发脑梗患，无新发脑出血病例，无死亡病例，无其他不良事件发生；术后6个月随访，A组无心脏并发症，无新发脑梗患者，无新发脑出血病例及死亡病例，无其他不良事件发生；B组无心脏并发症，3例（5．88％）新发脑梗患者，无新发脑出血病及死亡病例，无其他不良事件发生。术后30d总不良事件发生率为1．41％（1／71）。术后6个月随访总不良反应发生率为4．23％（3／71）。术后30d及6个月随访A、B组不良反应发生率对比差异均无统计学意义。此外，术后A组出现1例舌咽神经损伤，B组出现2例声嘶患者。术后6个月随访再狭窄患者A组0例，B组2例。结论使用CEA治疗一侧颈内动脉狭窄伴对侧颈内动脉闭塞患者且术中不使用转流管安全可行。

Objective To investigate the safety of carotid endarterectomy （CEA） without shunting in carotid artery stenosis （CAS） patients with contralateral carotid occlusion （CAO） under the protection of monitoring of cerebral blood oxygen saturation. Methods A total of 71 patients with CAS was enrolled in our research during 2013 to 2016. They were divided into two groups which were group A： 20 CAS patients with contralateral CAO, and group B： 51 CAS patients without contralateral CAO. All patients were given CEA without shunting during operation. One and 6 months following up was carried to observe the incidence of newly hemorrhage and infarction on operation side and adverse cardiac events. Results There was none adverse cardiac event and newly infarction. But there was 1 （5.00%） newly hemorrhage in group A during the 1 month following up. None adverse event was found in group B. During the 3 months following up, none adverse event was found in group A and 3 （5.88%） newly infarction patients were found in group B. However, there was no significant difference between group A and group B. Conclusion CEA without shunting in CAS patients with contralateral carotid occlusion under the protection of monitoring of cerebral blood oxygen saturation is an efficient and safe way to improve the patients,living quality.