颈动脉内膜剥脱术中选择性转流的初步研究

Preliminary study of selective shunting in carotid endarterectomy

目的评估全身麻醉下颈动脉内膜剥脱术(CEA)中选择性转流的中远期效果。方法回顾性分析2013年3月至2019年6月中山大学附属第一医院血管外科接受CEA术患者129例,根据术中是否应用转流管分为转流组48例和非转流组81例。术后3个月行头颈部彩超检查,之后每6个月至1年常规随访1次,比较2组患者中远期总体生存率和无再狭窄生存率。应用SPSS 20.0统计软件对数据进行分析。依据数据类型采用t检验或χ2检验进行组间比较。Kaplan-Meier分析总体存活率和无再狭窄存活率。结果转流组相比非转流组伴对侧颈动脉闭塞比例高[29.2%(14/48)和3.7%(3/81)],差异具有统计学意义(P<0.001)。转流组相比非转流组颈动脉夹闭时间[(22.6±5.9)和(13.7±4.6)min]和手术时间[(168.4±63.3)和(143.0±50.2)min]长,术中出血量多[(108.0±65.2)和(69.8±53.9)ml],住院时间短[(5.5±1.4)和(6.1±1.7)d],术中应用补片比例高[60.4%(21/48)和25.9%(29/81)],差异均具有统计学意义(P<0.05)。术后6周2组均无患者死亡,转流组相比非转流组脑卒中[2.1%(1/48)和1.2%(1/81)]和同侧颈动脉再狭窄[4.2%(2/48)和1.2%(1/81)]差异无统计学意义(χ2=0.142,P=0.706;χ2=1.141,P=0.285)。Kaplan-Meier分析结果表明2组患者中远期总体生存率(χ2=0.287,P=0.592)和无再狭窄生存率(χ2=0.285,P=0.593)差异均无统计学意义(P>0.05)。结论CEA术中选择性不使用转流管对中远期生存率和无再狭窄生存率无影响。

Objective To evaluate mid-and long-term effect of selective shunting in carotid endarterectomy(CEA)under general anesthesia.Methods A retrospective analysis was made of 129 patients who received CEA in Department of Vascular Surgery of the First Affiliated Hospital of Sun Yatsen University from March 2013 to June 2019.They were divided into shunting group(n=48)and non-shunting group(n=81).Color Doppler ultrasound was performed for the head and neck at 3 months after operation.The patients received a follow-up visit once every 6 months to 1 year.The two groups were compared in the overall survival rate and restenosis-free survival rate.SPSS statistics 20.0 was used to analyze the data.Depending on data type,t test orχ2 test was used to compare the two groups.Kaplan-Meier was used to analyze overall survival and restenosis-free survival rate.Results The shunting group had a higher occlusive rate of contralateral carotid artery than the non-shunting group[29.2%(14/48)vs 3.7%(3/81)],the difference being statistically significant(P<0.001).Compared with the non-shunting group,the shunting group had longer clamping time[(22.6±5.9)vs(13.7±4.6)min]and operation time[(168.4±63.3)vs(143.0±50.2)min],more intraoperative bleeding[(108.0±65.2)vs(69.8±53.9)ml],shorter length of hospital stay[(5.5±1.4)vs(6.1±1.7)d],higher usage of patch[60.4%(21/48)vs 25.9%(29/81)],all the differences having statistical significance(P<0.05 for all).No death occurred in both groups at 6 weeks after operation.There was no significant difference in stroke[2.1%(1/48)vs 1.2%(1/81)]and carotid restenosis[(4.2%(2/48)vs 1.2%(1/81)]between the two groups(χ2=0.142,P=0.706;χ2=1.141,P=0.285).Kaplan-Meier analysis showed no significant difference in the overall survival rate(χ2=0.287,P=0.592)and restenosis-free survival rate(χ2=0.285 P=0.593)between the two groups(P>0.05).Conclusion The selective use of carotid artery shunt in CEA has no effect on the long-term survival rate and restenosis-free survival rate.