11例头颈部动脉闭塞患者开通术治疗分析

发布时间：2018-07-10 06:47

本文选题：头颈部动脉闭塞 + 血管内介入治疗　；参考：《吉林大学》2017年硕士论文

【摘要】：慢性头颈部动脉闭塞是缺血性脑卒中的重要病因之一,导致了15%-25%的缺血性脑卒中,即使在最佳药物治疗方案的情况下,病变血管侧2年内发生缺血性卒中的风险仍能达到10%-15%。头颈部动脉闭塞的治疗目前是一项世界性的难题,内科药物治疗包括抗血小板聚集、抗凝、降血脂、控制血压等。外科手术治疗主要是单纯颈动脉内膜剥脱术及颅内外搭桥术。近年来随着神经介入材料及影像学的发展,血管内介入开通术及杂交手术在临床上开展起来。但目前学者间对于症状性头颈部动脉闭塞患者的手术治疗尚存争议,部分学者认为由于颈动脉闭塞患者手术技术难度大再通率低,术后并发症多,风险高,不建议行开通术治疗。另有一部分学者认为在病例进行严格筛选的情况下,对颈动脉闭塞患者实施CEA是安全的,能获得良好的中期通畅率及神经功能恢复,改善脑供血状况。目的:研究头颈部动脉闭塞再通手术的适应症,探讨再通术后并发症及预防措施。方法:收集吉林大学第二医院2015年1月~2016年12月期间收住院的11例头颈部动脉闭塞行再通术治疗患者的临床资料及随访资料,并结合相关文献资料进行分析。结果:男性患者7例(63.6%),女性4例(36.4%)。年龄50~75岁,平均为61.4岁。临床症状主要表现为头晕的患者2例,一侧肢体活动障碍4例,言语障碍伴一侧肢体活动不灵2例,视物不清2例,一过性意识不清1例。患者入院后1-3日内行头颈部血管造影检查(包括CTA、MRA、血管彩超)明确病变血管。其中,双侧ICA闭塞1例(9.1%),左侧ICA闭塞6例(54.5%),左ICA合并右CCA闭塞1例(9.1%),单侧VA闭塞2例(18.2%)。手术方式:血管内介入开通术8例(72.7%)、杂交手术的3例(27.3%)。术后疗效采用改良Rankin量表进行评分。评分为0分的患者3例(27.3%);1分的2例(18.2%);2分的3例(27.3%);3分的2例(18.2%);6分的1例(9.1%)。结论:1、血管内介入开通术及杂交手术治疗头颈部动脉闭塞技术上可行。2、血管内介入开通术及杂交手术能有效改善患者神经功能障碍。
[Abstract]:Chronic head and neck artery occlusion is one of the important causes of ischemic stroke, resulting in 15 to 25% of ischemic stroke. Even under the best drug therapy, the risk of ischemic stroke in the diseased vascular side can reach 10 to 15 percent within 2 years. The treatment of head and neck artery occlusion is a worldwide problem. Medical treatment includes antiplatelet aggregation, anticoagulant, lowering blood lipid, controlling blood pressure, etc. The main surgical treatment is carotid endarterectomy and extracranial bypass grafting. In recent years, with the development of nerve interventional materials and imaging, intravascular interventional patency and hybrid surgery have been carried out in clinic. However, there are still controversies among scholars about the surgical treatment of symptomatic head and neck artery occlusion. Some scholars believe that because of the low rate of difficulty in the operation of the patients with carotid artery occlusion, there are many postoperative complications and high risk. Open surgery is not recommended. Some other scholars believe that under the condition of strict screening of patients with carotid artery occlusion, CEA is safe, can obtain a good medium-term patency rate and neural function recovery, and improve the cerebral blood supply. Objective: to study the indications of recanalization of head and neck artery occlusion and discuss the complications and preventive measures. Methods: the clinical data and follow-up data of 11 patients with recanalization of head and neck artery occlusion were collected from January 2015 to December 2016 in the second Hospital of Jilin University. Results: there were 7 males (63.6%) and 4 females (36.4%). The average age was 61.4 years. The main clinical symptoms were dizziness in 2 cases, motor disorder in one side in 4 cases, speech disorder with side limb inactivity in 2 cases, blurred vision in 2 cases, and transient confusion in 1 case. Head and neck angiography (including CTAM RAA, color Doppler ultrasound) was performed within 1-3 days after admission to identify the diseased vessels. Bilateral ICA occlusion was found in 1 case (9.1%), left ICA occlusion in 6 cases (54.5%), left ICA with right CCA occlusion in 1 case (9.1%) and unilateral VA occlusion in 2 cases (18.2%). The operative methods were as follows: 8 cases (72.7%) underwent intravascular interventional surgery and 3 cases (27.3%) underwent hybrid surgery. The postoperative efficacy was evaluated by modified Rankin scale. There were 3 patients with 0 score (27.3%), 2 patients with 1 score (18.2%), 3 patients with 2 scores (27.3%), 2 patients with 3 scores (18.2%) and 1 patient with 6 scores (9.1%). Conclusion: the technique of intravascular interventional operation and hybrid surgery for the treatment of head and neck artery occlusion is feasible. Intravascular interventional patency and hybrid surgery can effectively improve the neurological dysfunction of the patients.
【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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