颈动脉外翻内膜剥脱术治疗颈内动脉狭窄短期疗效及对认知功能的影响

The short-term effect of carotid eversion endarterectomy in the treatment of internal carotid stenosis and its effect on cognitive function

目的探讨颈动脉外翻内膜剥脱术(CEE)治疗颈内动脉狭窄的短期疗效和对认知功能的影响。方法前瞻性连续入组南京鼓楼医院和徐州市中心医院2015年1月至2016年12月明确诊断为颈内动脉狭窄的患者103例,其中男性88例,女性15例,年龄(56±8.7)岁(范围:41~76岁)。患者均施行CEE,术前行颈部CTA及彩超评估颈内动脉狭窄程度。简易精神状态量表(MMSE)评分和蒙特利尔认知评估量表(MoCA)评分评估患者术前、术后的认知功能。记录手术时间、术中出血量和阻断颈动脉时间。随访采用颈动脉超声评估颈内动脉再狭窄程度。结果手术时间为(90±27.9)min,术中阻断颈动脉时间为(12±3.1)min,手术出血量为(60±30.6)ml,术后出现神经损伤4例,脑出血1例,脑梗死2例,颈部血肿1例,伤口愈合不良2例。随访时间18个月,术后6、12个月颈动脉再狭窄<50%各1例及3例;术后12个月再狭窄≥50%为1例;术后18个月再狭窄<50%为4例。术后第1天MoCA评分高于术前,差异有统计学意义[(23.8±4.7)分比(21.7±2.7)分,t=4.65,P<0.001],术后MMSE评分虽然高于术前,但差异无统计学意义[(25.15±3.76)分比(24.41±2.2)分,t=1.72,P=0.086]。结论CEE治疗颈内动脉狭窄具有良好的短期临床疗效和血管通畅率,同时可以改善患者的认知功能。

Objective To assess the short-term effect of carotid eversion endarterectomy(CEE)in the treatment of internal carotid artery stenosis and its effect on cognitive function.Methods A prospective cohort clinical analysis was conducted in 103 patients with internal carotid artery stenosis who underwent CEE from January 2015 to December 2016 in Nanjing Drum Tower Hospital and Xu Zhou Central Hospital.There were 88 males and 15 females,age was(56±8.7)years(range:41-76 years).Preoperative carotid CTA and color Doppler ultrasound were used to assess the degree of stenosis of internal carotid artery.Perioperative bleeding volume and time of blocking carotid artery were recorded.The mini-mental state examination(MMSE)score and Montreal cognitive assessment(MoCA)score were used to assess the cognitive function of patients before and after surgery.Carotid artery ultrasound was used to assess the degree of internal carotid artery stenosis following up for 18 months.Results The operative time was(90±27.9)min.The time of carotid artery occlusion during operation was(12±3.1)min,and the intraoperative blood loss was(60±30.6)ml.There were four patients manifesting neurological injury,one cerebral hemorrhage,two cerebral infarction,one cervical hematoma,and two poor wound healing.Restenosis<50%occurred in 1 patient 6 months after surgery.At 12 months after surgery,there were 3 patients with restenosis<50%and 1 patient with restenosis≥50%and<70%.Four patients showed restenosis<50%18 months after surgery.Postoperative MoCA score(23.8±4.7)was significantly higher than preoperative score(21.7±2.7,t=4.65,P<0.001).But there was no significant difference in MMSE scores before and after surgery(24.41±2.2 vs 25.15±3.76,t=1.72,P=0.086).Conclusion CEE has good short-term clinical effect and patency rate in the treatment of internal carotid artery stenosis,and can improve cognitive function.