CAJ | 학술논문

显微颈动脉内膜切除术治疗颈动脉狭窄和闭塞
현미경동맥내막절제술치료경동맥협착화폐새
Clinical analysis of microsurgical carotid endarterectomy for carotid stenosis and occlusion

万方数据

中华外科杂志中華外科雜誌 중화외과잡지
CHINESE JOURNAL OF SURGERY
2009年 6期 407-410 ,共4页

王涛%武文元%王凯%刘二兵%闫海成%高乃康%王飞%刘海波%武强%戴志刚

왕도%무문원%왕개%류이병%염해성%고내강%왕비%류해파%무강%대지강

颈动脉狭窄%动脉粥样硬化%颈动脉内膜切除术%转流%显微手术頸動脈狹窄%動脈粥樣硬化%頸動脈內膜切除術%轉流%顯微手術
경동맥협착%동맥죽양경화%경동맥내막절제술%전류%현미수술
Carotid stenosis%Atheroscleorosis%Endarterectomy,carotid%Eversion%Microsurgery

目的:探讨颈动脉内膜切除术治疗颈动脉粥样硬化性狭窄和闭塞的疗效.方法2005年8月至2008年11月16例患者均经彩色超声、磁共振血管成像(MRA)、CTA、数字减影血管造影证实为中重度颈动脉狭窄,14例狭窄率为60%～99%,2例完全闭塞;12例行标准颈动脉内膜切除术,4例行外翻式颈动脉内膜切除术;2例术中放置转流管;1例术中行补片成形术.所有手术均借助显微镜完成.结果:围手术期及术后随访无卒中、短暂性脑缺血及死亡病例.术后均经彩色超声、MRA检查证实颈内动脉血流通畅,术后原症状改善或消失.1例并发消化道出血,1例围手术期有声嘶、呛水,对症治疗后症状消失,余均无并发症.结论:颈动脉内膜切除术是治疗颈动脉狭窄的有效方法,采用不同术式及技术,对不同颈动脉病变可以达到最佳治疗效果;显微手术有助于高位分叉颈动脉的显露,能有效避免颅神经损伤及其他并发症.
목적:탐토경동맥내막절제술치료경동맥죽양경화성협착화폐새적료효.방법2005년8월지2008년11월16례환자균경채색초성、자공진혈관성상(MRA)、CTA、수자감영혈관조영증실위중중도경동맥협착,14례협착솔위60%～99%,2례완전폐새;12례행표준경동맥내막절제술,4례행외번식경동맥내막절제술;2례술중방치전류관;1례술중행보편성형술.소유수술균차조현미경완성.결과:위수술기급술후수방무졸중、단잠성뇌결혈급사망병례.술후균경채색초성、MRA검사증실경내동맥혈류통창,술후원증상개선혹소실.1례병발소화도출혈,1례위수술기유성시、창수,대증치료후증상소실,여균무병발증.결론:경동맥내막절제술시치료경동맥협착적유효방법,채용불동술식급기술,대불동경동맥병변가이체도최가치료효과;현미수술유조우고위분차경동맥적현로,능유효피면로신경손상급기타병발증.
Objective To evaluate the clinical effects of carotid endarterectomy for carotid stenosis and occlusion. Methods From August 2005 to November 2008 moderate and severe carotid stenosis or occlusion were found in 16 patients by Doppler ultrasonography (DUS), MRA, CTA, DSA. The stenosis degree ranged from 60% to 99% in 14 patients and complete occlusion in 2 patients. Twelve patients underwent standard carotid endarterectomy (sCEA) in whom 2 patients were placed carotid shunt and 1 patient underwent carotid patch angioplasty. Four patients underwent eversion carotid endarterectomy (eCEA). All operations were performed by microscope. Results There was no stroke,transient ischemic attack and mortality perioperatively and during follow-up from 1 month to 3 years. The ICA flow detected by follow-up duplex scan and MRA was unobstructed. The primary cerebral ischemic symptoms were obviously improved or disappeared after operation. The postoperative complications included one case of upper gastrointestinal hemorrhage and one ease of hoarseness and bucking, which disappeared after medical treatment. Conclusions CEA is an effective way for treating carotid stenosis. Different operative methods and techniques deal with different carotid lesions to achieve better effect. Microsurgical technique is useful for exposure of high ICA bifurcation and avoid effectively cranial nerve injury and other complications.