颈动脉内膜剥脱术治疗症状性颈内动脉狭窄的疗效分析

Clinical Effect of Carotid Endarterectomy in the treatment of Symptomatic Internal Carotid Artery Stenosis

目的 探讨颈动脉内膜剥脱术治疗症状性颈内动脉狭窄的效果.方法 回顾性分析2016年1月-2018年12月在朝阳市中心医院神经外科,行颈动脉内膜剥脱术治疗的46例症状性颈内动脉狭窄患者的临床资料,从神经功能、脑血流动力学及围手术期和远期不良事件等方面评价其治疗效果及安全性.结果 与术前相比,术后3个月患者狭窄段血管内径增大、狭窄段收缩期峰值血流速度降低,差异均有统计学意义(P<0.05).患者术后3个月改良Rankin量表评分较术前降低、蒙特利尔认知评估量表评分较术前提高,差异均有统计学意义(P<0.05).围手术期不良事件:术后出现脑过度灌注综合征、颈部切口积脓、心律失常、突发脑干出血死亡各1例.远期不良事件:术后4个月和8个月出现脑梗死各1例;术后5个月出现动脉内夹层1例.结论 颈动脉内膜剥脱术可有效改善症状性颈内动脉狭窄患者的神经功能和脑供血情况,疗效确切,安全性高.

Objective The aim of the study is to investigate the efficacy of carotid endartcrectomy(CEA)in treatment of symptomatic internal carotid artery stenosis.Methods A retrospective study was conducted in 46 patients with symptomatic internal carotid stenosis who undergoing CEA in Chaoyang ccntral hospital from January 2016 to December 2018.The neurological function,cerebral hemodynamics,perioperative complications and long-term complications in the patients were evaluated.Results Carotid duplex ultrasound results showed that the vascular diameter of the stenotic segment of the patient was significantly increased(P<0.05),and the peak systolic blood flow velocity was significantly decreased(P<0.05)than those before surgery.The modified Rankin Scale(mRS)score was significantly lower(P<0.05),and the Montreal Cognitive Assessment Scale(MoCA)score was significantly higher than those before surgery(P<0.05).Perioperative complications occurred in 4 cases,including 1 case of cerebral hyperperfusion syndrome,1 case of cervical incision pus,1 case of arrhythmia,1 case death of cerebral stem hemorrhage;and Ion g-term complicatio ns occurred in 3 cases,in eluding 2 cases of cerebral lac un ar infarctio n,I case of carotid artery dissection after 5 months.Conclusion CEA can significantly improve the neurological function and cerebral blood supply for patients with symptomatic internal carotid artery stenosis.It is of great clinical efficacy and security.