复合手术治疗慢性颈总动脉闭塞病变的应用分析

Application analysis of composite surgery in the treatment of chronic common carotid artery occlusion

目的探讨复合手术治疗慢性颈总动脉闭塞(CCAO)病变的临床疗效。方法采用回顾性描述性研究方法收集2020年10月—2023年12月首都医科大学宣武医院应用复合手术治疗的7例慢性CCAO患者的临床资料。7例患者中,男性6例,女性1例;年龄(66.7±10.9)岁,年龄范围52~83岁。术后采取门诊或电话随访,术后3个月、6个月及1年复查颈动脉超声或CT血管造影明确血管通畅情况。分析手术方式的选择及临床疗效。正态分布的计量资料以均数±标准差(±s)表示,偏态分布的计量资料以M(Q_(1),Q_(3))表示,计数资料以频数表示。结果7例患者术前检查明确均为CCAO,其中左侧6例,右侧1例;3例累及颈总动脉中远段,1例累及近中段,中段和远段病变各1例,颈总动脉全程闭塞1例。所有手术均顺利完成,其中4例行颈动脉内膜剥脱术联合支架置入,3例行颈动脉内膜剥脱术后未再置入支架。术后1例患者出现颈部血肿,其余患者术后恢复良好,无并发症及死亡病例。随访时间13.5(4.0,20.5)个月,7例患者中1例失访,6例获得有效随访;6例患者颈总动脉均保持通畅,随访期间均无短暂性脑缺血发作或脑卒中发生。结论复合手术可以用于治疗慢性CCAO病变,手术安全可行,短期效果满意。

ObjectiveTo investigate the clinical effect of composite surgery in the treatment of chronic common carotid artery occlusion(CCAO).MethodsA retrospective descriptive study was conducted.The clinical data of 7 patients with CCAO admitted to Xuanwu Hospital,Capital Medical University from October 2020 to December 2023 were collected retrospectively.There were 6 males and 1 female.The age was(66.7±10.9)years,ranging from 52 to 83 years.Outpatient or telephone follow-up were conducted after surgery,carotid artery ultrasound or computed tomography angiography were performed at 3 months,6 months,and 1 year postoperatively to determine vascular patency.The selection of surgical methods and clinical effect were analyzed.Normally distributed measurement data were expressed as mean±standard deviation(±s).The measurement data of skewed distribution were expressed by M(Q_(1),Q_(3)).Count data were expressed as frequency.ResultsAll 7 patients were diagnosed with chronic CCAO before operation,6 on the left and 1 on the right.3 cases affected the middle and distal segments of the common carotid artery,1 case affected the proximal segment,and 1 case each affected the middle and distal segments,the remaining case involves the entire common carotid artery.All the procedures were successfully performed,among which 4 cases underwent carotid endarterectomy combined with stent placement,and 3 cases did not receive stent placement after carotid endarterectomy.1 patient developed neck hematoma after surgery and the remaining patients recovered well after surgery without any complications or deaths.The follow-up time was 13.5(4.0,20.5)months;1 patient was lost to follow-up,and 6 patients received effective follow-up.the common carotid artery remained unobstructed in all 6 patients,and there were no transient ischemic attacks or strokes during the follow-up period.ConclusionComposite surgery is a safe and feasible method that can be used to treat chronic CCAO lesions,and has satisfactory short-term results.