开放手术重建颅外段椎动脉的疗效分析

Clinical Effect of Surgical Reconstruction of Extracranial Vertebral Artery

目的探讨开放手术重建颅外段椎动脉的临床疗效并总结其治疗经验。方法收集首都医科大学附属北京天坛医院血管外科2018年9月至2022年6月应用开放手术重建颅外段椎动脉的15例患者的临床资料,回顾性分析椎动脉不同部位病变的治疗策略、手术的适用范围、临床疗效及相关并发症。结果11例行椎动脉V1段-颈总动脉转位术、2例行椎动脉V1段内膜剥脱术、2例行椎动脉V3段-颈外动脉搭桥术或转位术。手术时间120~340 min,中位手术时间240 min。术中出血50~300 ml,中位出血量100 ml。颈总动脉阻断时间12~25 min,中位阻断时间16 min。围手术期均无心脏意外、脑过度灌注综合征、脑出血及淋巴漏的发生。术后脑梗死1例,不完全性Horner综合征3例。15例患者获随访4~45个月,中位随访时间26个月。随访期间吻合口及桥血管均通畅,无新发脑梗死,无颅内缺血表现。结论开放手术重建颅外段椎动脉安全可行、效果确切,需根据不同病变部位采取个体化的重建策略。

Objective To evaluate the effect of surgical reconstruction of extracranial vertebral artery and to summarize the experience.Methods The clinical data of 15 patients undergoing surgical reconstruction of extracranial vertebral artery from September 2018 to June 2022 were collected.The operation methods,operation duration,intraoperative blood loss,operation complications,and relief of symptoms were retrospectively analyzed.Results Eleven patients underwent vertebral artery(V1 segment)to common carotid artery transposition,two patients underwent endarterectomy of V1 segment,two patients underwent V3 segment to external carotid artery bypass or transposition.The operation duration,intraoperative blood loss,and blocking time of common carotid artery varied within 120-340 min,50-300 ml,and 12-25 min,with the medians of 240 min,100 ml,and 16 min,respectively.There was no cardiac accident,cerebral hyperperfusion syndrome,cerebral hemorrhage or lymphatic leakage during the perioperative period.One patient suffered from cerebral infarction and three patients suffered from incomplete Horner’s syndrome after the operation.During the follow-up(4-45 months,median of 26 months),there was no anastomotic stenosis,new cerebral infarction or cerebral ischemia.Conclusion Surgical reconstruction of extracranial vertebral artery is safe and effective,and individualized reconstruction strategy should be adopted according to different conditions.