颈动脉内膜剥脱术治疗高龄颈动脉狭窄患者的疗效分析

Efficacy of carotid endarterectomy in very old patients with carotid stenosis

目的探讨颈动脉内膜剥脱术(CEA)治疗高龄颈动脉狭窄患者的疗效。方法回顾性分析北京协和医院2010年1月至2015年12月行CEA的颈动脉狭窄患者,根据年龄分为≥70岁组和<70岁组。随访至少1年。比较两组患者的治疗效果、治疗安全性及1年内出现再狭窄及再发卒中的情况。组间比较采用t检验或卡方检验。结果研究期间共行CEA 722例,其中≥70岁组279例,<70岁组443例。两组患者手术相关死亡、术后30 d内缺血性卒中、心肌梗死发生率差异均无统计学意义(P>0.05),≥70岁组过度灌注发生率显著高于<70岁组(6.8%vs 3.2%,P<0.05)。1年随访结果显示,两组患者颈动脉再狭窄率及再发卒中率差异无统计学意义(P>0.05)。结论高龄患者接受CEA有较高的安全性,术前应全面评价患者基础情况,以减少术后并发症发生率。

Objective To analyze the efficacy of carotid endarterectomy （CEA） in the very old patients with carotid stenosis. Methods The patients with arteriosclerotic carotid stenosis treated with CEA in our hospital from January 2010 to December 2015 were recruited in this study. They were divided into ≥70-year-old group and 〈70-year-old group. All the patients were followed up for at least 1 year. The efficacy,treatment safety,and incidence rates of restenosis and secondary stroke after the procedure were observed and compared between the 2 groups. SPSS statistics 19.0 was used to analyze the data. Student＇s t test or Chi-square test （Fisher exact probability method） was used to make the comparison between groups for different data types. Results There were 722 patients enrolled in this study,including 279 patients being assigned into≥70-year-old group and 443 patients into 〈70-year-old group. There were no significant differences in surgery-related death,30-day ischemic stroke, or acute myocardial infarction between the 2 groups （P〉0.05）. ≥70-year-old group had obviously high ratio of hyperperfusion than 〈70-year-old group（6.8% vs 3.2%,P〈0.05）. After 1 year＇s follow-up, no significant difference was seen in the incidence rates of carotid artery restenosis and secondary stroke between the 2 groups. Conclusion CEA is safe for the very old patients. However, the conditions of the elderly patients should be evaluated before operation in order to reduce the occurrence of post-operative complications.