颈动脉内膜切除术的手术技巧与临床疗效

发布时间：2018-04-15 04:28

本文选题：颈动脉狭窄 + 颈动脉内膜切除术　；参考：《山东大学》2014年硕士论文

【摘要】：目的： 1.探讨颈动脉内膜切除术治疗颈动脉狭窄的手术技巧,以提高手术疗效,减少术中不良事件及术后并发症； 2.术后长期随访以观察其临床疗效。方法：回顾性分析天津市环湖医院神经外科2010年10月-2013年10月53例因颈动脉狭窄行颈动脉内膜切除术(Carotid Endarterectomy,CEA)患者的临床资料,其中男性39例,女性14例,男：女之比为2.78：1.00,年龄40～78岁,平均(60.34±8.92)岁；病程2天至4年。临床表现为短暂性黑蒙(8例)、偏身肢体瘫痪或无力(34例)、短暂性失语(16例)、头晕(22例),亦可完全无症状(2例)；同时伴发有腔隙性脑梗死或陈旧性脑梗死(37例)、糖尿病(16例)高血压(43例)和高脂血症(39例)。狭窄位于右侧颈动脉者26例、左侧15例、双侧12例,其中轻度狭窄(30%)0例、中度狭窄(30%～69%)35例、重度狭窄(70%-99%)16例、完全闭塞(100%)2例,双侧狭窄者根据临床症状决定手术侧别,完全闭塞者依据数字剪影血管造影(digital subtraction angiography,DSA)判定远端血流是否通畅,通畅者给予手术,手术类别可分为单纯颈动脉内膜切除术(50例)、颈动脉内膜切除术联合动脉瘤夹闭术(2例)、颈动脉支架植入术(carotid artery stenting,CAS)后因管腔狭窄行颈动脉内膜切除术并支架取出术(1例)。本组病例均行单侧手术,2例完全闭塞者DSA示左侧颈内动脉远端血流通畅,均行左侧CEA。术后3至24月内进行电话随访,根据该组患者术前及术后症状改善的资料,进行定量资料的配对设计,并应用SAS数据分析软件进行分析。结果： 1.术后1例因突发心肌梗死死亡；2例出现手术侧颈部皮肤麻木；1例出现声音嘶哑,考虑全身麻醉气管插管损伤所致,经布地奈德雾化吸入治疗症状消失；3例术后仍有轻度短暂性脑缺血发作(transient ischemic attack,TIA),但无脑卒中或脑梗死病例,术后颈部CT血管造影(computed tomography angiography,CTA)和核磁灌注功能成像(functional magnetic resonance imaging,fMRI)检查提示颈动脉形态良好、血流通畅；脑血流灌注有不同程度改善。 2.所有患者随访3-24个月,术前症状均有不同程度改善,TIA症状消失。其中,2例患者出现手术侧颈部皮肤麻木感,术后3个月症状消失；9例仍有反应迟钝、记忆力减退、动作迟缓等慢性脑缺血症状,但程度较术前有明显的改善；3例术后短期内表现为TIA,术后2个月消失。结论： 1.统计结论：t=-13.740,P0.0001,按α=0.05水准,认为差异有统计数意义,CEA术后患者症状明显改善； 2.颈动脉内膜切除术是治疗颈动脉狭窄安全、有效的外科治疗方法； 3.正确合理的选择手术适应症、医师娴熟的手术技术及技巧的应用是保证手术成功、提高疗效的关键； 4.颈动脉内膜切除术是颈动脉支架置入术后再狭窄的补救治疗措施。
[Abstract]:Objective:1.To explore the surgical techniques of carotid endarterectomy in the treatment of carotid artery stenosis in order to improve the curative effect and reduce the adverse events and postoperative complications.2.Postoperative long-term follow-up to observe its clinical efficacy.Methods:The clinical data of 53 patients undergoing carotid endarterectomy (Carotid Endarterectomy1) due to carotid artery stenosis from October 2010 to October 2013 in Tianjin Huanghu Hospital were retrospectively analyzed. There were 39 males and 14 females, the ratio of male to female was 2.78: 1.00, aged 400-78 years.The mean age was 60.34 卤8.92 years, the course of disease was 2 days to 4 years.The clinical manifestations were transient black mongolicus in 8 cases, hemiplegia or weakness in 34 cases, transient aphasia in 16 cases, dizziness in 22 cases, complete asymptomatic syndrome in 2 cases, accompanied by lacunar cerebral infarction or old cerebral infarction in 37 cases, glucose in 37 cases.Hypertension (43 cases) and hyperlipidemia (39 cases).There were 26 cases of stenosis in the right carotid artery, 15 cases on the left side and 12 cases on the bilateral side. Among them, 30 cases were mild stenosis, 306935 cases were moderate stenosis, 16 cases were severe stenosis, 16 cases were located in the right carotid artery, and 2 cases were completely occluded. The patients with bilateral stenosis decided the operation side according to the clinical symptoms.The patients with complete occlusion were judged by digital subtraction angiography to determine whether the distal blood flow was patency and the patency was performed.The types of operation could be divided into 50 cases of carotid endarterectomy, 2 cases of carotid endarterectomy combined with aneurysm clipping, and 1 case of carotid endarterectomy and stent removal after carotid artery stenting after carotid artery stenting.All the patients underwent unilateral operation and 2 patients with complete occlusion underwent DSA showing patency of the distal end of the left internal carotid artery.The patients were followed up by telephone from 3 to 24 months after operation. According to the data of symptom improvement before and after operation, the pairing design of quantitative data was carried out and analyzed by SAS data analysis software.Results:1.Postoperative death due to sudden myocardial infarction occurred in 2 patients with postoperative neck skin numbness and hoarseness in 1 case, which was caused by tracheal intubation injury under general anesthesia.The symptoms disappeared after budesonide atomization inhalation in 3 patients with mild transient ischemic attack-TIAA, but there was no stroke or cerebral infarction.Ct tomography angiography and nuclear magnetic perfusion functional magnetic resonance imagingfMRI showed that the carotid artery was in good shape and the blood flow was patency, and cerebral blood perfusion was improved to some extent.2.All patients were followed up for 3-24 months.Among them, 2 cases had skin numbness on the side of the neck, 9 cases had chronic cerebral ischemia symptoms, such as slow reaction, memory loss, slow movement and so on, the symptoms disappeared 3 months after operation, and 9 cases were still suffering from chronic cerebral ischemia.However, the degree of TIA was significantly improved in 3 cases after operation and disappeared 2 months after operation.Conclusion:1.Conclusion the statistical results showed that the difference was statistically significant in the improvement of postoperative symptoms of CEA patients according to the level of 伪 -0.05.2.Carotid endarterectomy is a safe and effective surgical treatment for carotid stenosis.3.The correct and reasonable choice of surgical indications and the application of skilled surgical techniques and techniques are the key to ensure the success of the operation and to improve the curative effect.4.Carotid endarterectomy is a remedy for restenosis after carotid stenting.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R653

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