38例双侧颈动脉重度狭窄的外科治疗

Surgical treatment of bilateral severe carotid artery in 38 patients

目的 比较不同手术方案对双侧颈动脉重度狭窄的治疗效果.方法 回顾性分析38例双侧颈动脉重度狭窄患者的临床资料,依据手术方式分成双侧颈动脉内膜剥脱术(双CEA组,10例)、双侧颈动脉支架成形术(双CAS组,13例)及CEA/CAS组(15例).结果 三组患者在临床症状改善上无明显差异(P=0.657).双CAS组术后3例(23.1%)患者出现低血压,明显高于其他两组(P=0.044).术后5例患者出现心动过缓,三组间比较差异无统计学意义(双CEA:双CAS:CEA/CAS=1:3:1,P=0.415).3例患者术后发生缺血性脑卒中,双CEA组1例(10%),双CAS组2例(15.4%),三组之间差异无统计学意义(P=0.309).术后高灌注综合征6例,三组之间比较差异无统计学意义(双CEA:双CAS:CEA/CAS=2:3:1,P=0.451).双CEA组和双CAS组术后各有1例患者出现心肌梗死,经统计学分析后未见明显差异(P=0.487).不良事件总和上,三组之间有显著差异(P=0.008).结论 双侧CAS手术在安全性上要劣于其他两种手术方案.

Objective To evaluate the treatment outcomes in patients with bilateral severe carotid artery who underwent three different surgical methods. Methods The clinical data of 38 patients with se-vere bilateral carotid stenosis were retrospectively analyzed. Thirty eight patients were divided into bilateral carotid endarterectomy (double CEA, 10 cases), bilateral carotid artery stenting (double CAS , 13 cases), and CEA combined with CAS (CEA/CAS, 15 cases). Results There was no significant difference in the clinical benefit of the three groups (P = 0.657). There were 3 patients (23.1%) with low blood pressure in the bilat-eral CAS group, which was significantly more than other two groups (P = 0.044). 5 cases with Bradycardia were observed postoperatively(double CEA:double CAS:CEA/CAS=1:3:1), and there was no statistically dif-ference between 3 groups (P = 0.415). 3 patients had ischemic stroke after operation, 1 case (10%) in dou-ble CEA group, 2 cases (15.4%) in double CAS group, and there was no significant difference among 3 groups(P=0.309). 6 patients with hyperperfusion syndrome among 3 groups was no significant (double CEA:double CAS:CEA/CAS=2:3:1,P=0.451).1 case with myocardial infarction in the double CEA and double CAS groups respectively, there was no difference among 3groups (P=0.487). The total adverse events in 3 groups was significant different (P=0.008). Conclusion The safety of Bilateral CAS operation was inferior to the other two kinds of surgical project.