颈动脉内膜剥脱手术进展

Progress of carotid endarterectomy

脑卒中是我国中老年人致死致残的重要病因,具有高发病率、死亡率及致残率的特点,其中缺血性脑卒中占比较高,严重危害了人们的生命健康。缺血性脑卒中常由颈动脉粥样硬化性狭窄引起,其主要治疗方式有口服药物和手术治疗。手术治疗中,颈动脉内膜剥脱术(CEA)是治疗颈动脉狭窄和预防缺血性脑卒中发生的重要方式,其有效性得到国内外多项大样本、多中心临床随机试验的验证。经过半个多世纪的不断发展,近年来围绕CEA手术的各方面问题均有不同程度进展。在我国,CEA手术尚未完全普及,不断加深对CEA手术的认识,合理选择术式、筛选术中监测手段有助于更好的在临床开展该项手术,降低手术相关并发症的发生概率,改善患者预后。现对颈动脉狭窄的适应证、术中监测、手术方式及相关并发症等问题予以综述,以期为临床工作提供一定的参考价值。

Stroke is an important cause of death and disability in the middle-aged and elderly in China,which has the characteristics of high morbidity,mortality and disability.Ischemic stroke is a major type of stroke that seriously endangers the lives and health.It is often caused by carotid atherosclerotic stenosis.Oral drugs and surgery are the common therapeutic strategies for ischemic stroke.In surgical treatment,carotid endarterectomy(CEA)is an important procedures for carotid stenosis and preventing ischemic stroke,and its effectiveness has been verified by a number of large-sample,multicenter clinical randomized trials at home and abroad.After more than half a century of continuous development,there have been varying degrees of progress in all aspects of CEA in recent years.In China,CEA has not been extensively performed.A continue deepening of the understanding of CEA,selection of a reasonable procedure and screening of intraoperative monitoring methods contribute to popularize CEA,lower its complications and improve the prognosis.This review describes the indications,intraoperative monitoring,surgical methods and related complications of carotid artery stenosis,thus providing some references for clinical work.