颈动脉内膜剥脱术与颈动脉支架植入术治疗颈动脉狭窄疾病的临床研究

发布时间：2018-05-08 06:06

本文选题：颈动脉内膜剥脱术 + 颈动脉支架植入术　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:脑卒中,即使是TIA,严重影响着患者的生活质量,又是致残的主要病因,世界卫生组织2012年公布的死亡原因中脑卒中在中高收入国家占首位[1],美国每年约有70万人发生脑卒[2]。因此,对颈动脉狭窄性疾病的治疗显得尤为重要。自1953年Michael De Bakey完成第一例CEA,至今,CEA已逐渐成为颈动脉狭窄性疾病治疗的金标准。但是近年来介入技术快速发展及操作者技术不断提高,CAS越来越多地被应用于缺血性脑卒中的治疗。二者孰优孰劣,越来越被现代学者及临床工作者关注,成为研究热点。本文回顾性分析我科自2010-2013年颈动脉狭窄患者的临床资料,筛查出经CEA或CAS治疗的患者,在术后再狭窄、围手术期重大心脑血管不良事件及术后切口并发症等方面的发生率对二者进行比较。方法:共纳入自2010-2013年182名在我科治疗的颈动脉狭窄患者,分为2组,108名患者行CEA治疗,74名患者行CAS治疗,男性121名,女性61名,年龄52-79岁之间。通过门诊随访追踪患者情况,要求患者分别于术后3个月、12个月、24个月回院检查,其中随访时间最短的是3个月,最长的为24个月,平均随访18.71±4.51个月。通过CTA或者多普勒彩色超声观察颈动脉血管的通常情况,如狭窄50%则定义为颈动脉再狭窄。随访内容主要为术后3个月及术后2年内再狭窄率、术后切口并发症发生率、及围手术期MACCE发生率。通过SPSS19.0软件进行卡方检验和t检验,当P0.05时有显著差异。比较两组患者术后切口并发症、再狭窄,及围手术期重大心脑血管不良事件等的发生率情况。结果:两组术后切口并发症并无显著差异;3个月内CEA组有2人发生再狭窄,CAS组有3人,无显著统计学差异(P值=0.67),CEA组其中1人术后24小时内多次出现一过性头痛、眩晕,触及颈动脉搏动不清,考虑急性血栓形成,立返手术室切开取栓,术后症状逐渐好转,另外1人术后3个月复查颈部动脉CTA时发现狭窄率约50%,但无明显临床症状,未予以特殊处理;CAS组3人复查颈动脉CTA时发现狭窄50%,伴头晕、一过性黑蒙等症状,其中2人行球囊扩张术后症状消失,1人再狭窄段位于颈总动脉分叉近心端,行自体大隐静脉转流术,术后症状消失。2年时CEA组有4人发生再狭窄,CAS组4人发生再狭窄,无显著统计学差异(P值=0.86),CEA组1人行二次颈动脉内膜剥脱术,术后症状消失,CAS组1人行二次颈动脉支架植入术,术后症状消失,其余患者均行保守治疗后症状好转;术后30天及2年TLR发生率无显著差异,且二次术后无再狭窄情况;CAS组较CEA组有较高的脑卒中发生率,为9.46%,尤其对于70岁以上患者发病率更高,为50%,这里脑卒中的发生率包括重大脑卒中及TIA,两组脑卒中发生率的差异主要来自小卒中的发生,重大脑卒中的发生率并无显著差异;两种手术方式在死亡率上取得较为满意的结果,总体死亡率较低,为1.65%;围手术期MACCE发生率,CEA组为3.70%,CAS组为5.41%,两组数据无明显统计学差异。结论:CEA组与CAS组在术后切口并发症、再狭窄、TLR及围手术期重大脑卒中/死亡/心梗等不良事件的发生率上均无显著差异,问世仅约16年的CAS,发展前景令人期待!而CEA,更适用于高龄患者。所以,二者对颈动脉狭窄疾病的治疗效果是相当的又是相辅相承的!
[Abstract]:Objective: stroke, even TIA, seriously affects the quality of life of the patients, and is the main cause of disability. In 2012, the WHO published the cause of death in the middle and high income countries which accounted for the first [1]. In the United States, about 700 thousand people have cerebral pawns every year, so the treatment of carotid stenosis is particularly important. Since 1953, the treatment of carotid artery stenosis is particularly important. Michael De Bakey completed the first case of CEA, so far, CEA has gradually become the gold standard for the treatment of carotid stenosis. However, in recent years, the rapid development of the interventional technique and the continuous improvement of operator technology, and more and more applications of CAS to the treatment of ischemic stroke. The two are better and worse, and are becoming more and more closely related to modern scholars and clinical workers. A retrospective analysis of the clinical data of patients with carotid stenosis in 2010-2013 years was reviewed. The incidence of postoperative restenosis, major peri operative cardiovascular adverse events and postoperative incision complications was compared between the two patients who had been treated with CEA or CAS. Methods: a total of 2010-2013 years 1 years were included. 82 patients with carotid stenosis treated in our department were divided into 2 groups, 108 patients were treated with CEA, 74 patients were treated with CAS, 121 men, 61 women and 52-79 years old. The patients were followed up for 3 months, 12 months and 24 months after 2 months, and the shortest follow-up time was the shortest, the longest was 3 months, the longest The average follow-up of 24 months was 18.71 + 4.51 months. The common carotid artery blood vessels were observed by CTA or Doppler color ultrasound. 50% of the stenosis were defined as carotid restenosis. The follow-up was mainly followed by 3 months after operation and 2 years after operation, the incidence of postoperative incision complications, and the incidence of MACCE in the perioperative period. Through SPSS19.0 The software carried out the chi square test and t test, and there were significant differences when P0.05. Compared the incidence of postoperative incision complications, restenosis, and perioperative major cardio cerebral vascular adverse events in the two groups. Results: there was no significant difference in postoperative incision complications between the two groups; in group CEA, there were 2 restenosis in group CEA, and there were 3 in group CAS, and no significant unification. The study difference (P value =0.67), in group CEA, 1 of them had a recurrent headache, dizziness, not clear carotid artery pulsation within 24 hours after operation, and the formation of acute thrombus was taken into consideration in the operation room. The symptoms gradually improved after the operation in the operation room. The other 1 people found that the stenosis rate was about 50%, but there was no obvious clinical symptom, but no obvious clinical symptoms were found in the other 1 patients after 3 months of operation. With special treatment, 3 people in group CAS reexamined the carotid artery CTA and found the symptoms of stenosis 50%, dizziness, and primary dark Mongolian, of which 2 of them disappeared after balloon dilatation, 1 restenosis was located in the proximal central end of the common carotid artery, and the autologous great saphenous vein reflow was performed. The restenosis occurred in the group of CEA after.2 years, and 4 in the CAS group occurred again. There was no significant difference in statistical difference (P value =0.86), 1 people in group CEA were treated with two times carotid endarterectomy, the symptoms disappeared, 1 patients in group CAS were treated with two carotid artery stenting, the symptoms disappeared, and the rest of the patients improved after conservative treatment; there was no significant difference in the incidence of TLR in 30 and 2 years after the operation, and there was no restenosis after two operations; CAS There was a higher incidence of stroke in the group than the CEA group, 9.46%, especially for patients over 70 years of age, with a higher incidence of 50%. The incidence of stroke included major stroke and TIA. The difference in the incidence of stroke in the two groups was mainly from the occurrence of the stroke, and there was no significant difference in the incidence of major stroke; the two surgical methods were in the mortality rate. The overall mortality rate was low, 1.65%, the incidence of MACCE in the perioperative period, the group CEA was 3.70%, the group CAS was 5.41%, and the two groups had no significant statistical difference. Conclusion: the incidence of postoperative complications, restenosis, TLR and major stroke / death / myocardial infarction in the CEA group and the CAS group were not obvious. The difference is that the CAS is only about 16 years old, and the prospect of development is expected! And CEA is more suitable for the elderly patients. Therefore, the treatment effect of the two on the stenosis of the carotid artery is equal and complementary to each other.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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