颈内动脉假性闭塞手术治疗的单中心经验总结

发布时间：2018-06-28 02:24

本文选题：动脉假性闭塞 + 颈动脉内膜切除术　；参考：《复旦学报(医学版)》2017年04期

【摘要】：目的评价颈内动脉假性闭塞(atheromatous pseudo-occlusion,APO)手术治疗的安全性及有效性。方法对复旦大学附属中山医院2011年12月至2016年6月间接受颈动脉内膜切除术的颈动脉狭窄患者资料进行回顾性分析,其中研究组为APO患者32例,对照组为重度狭窄(70%~99%)患者124例。对两组围手术期各主要及次要并发症、随访中的同侧缺血性脑卒中复发率、再狭窄率及死亡率进行比较。结果围手术期主要并发症:APO组发生心梗1例(3.1%),无缺血性脑卒中、脑出血及死亡病例;对照组发生缺血性脑卒中2例(1.4%),心肌梗死6例(4.2%),死亡1例(0.7%)。次要并发症:APO组发生切口渗血1例(3.1%),肺部感染2例(6.3%),高灌注综合征2例(6.3%);对照组发生切口渗血3例(2.1%),切口感染2例(1.4%),肺部感染4例(2.8%),颅神经损伤2例(1.4%),高灌注综合征2例(1.4%)。术后随访6~60个月,平均随访(35.3±17.5)个月。APO组1例(3.1%)同侧缺血性脑卒中复发,4例(12.5%)发生再狭窄,死亡3例(9.4%),死因均非神经系统疾病。对照组同侧缺血性脑卒中复发8例(5.6%),再狭窄9例(6.3%),死亡8例(5.6%)。两组间围手术期各主要及次要并发症,随访中的同侧缺血性脑卒中复发率、再狭窄率、死亡率的差异均无统计学意义。结论对APO患者行颈动脉内膜切除术治疗安全有效,围手术期及随访结果满意。
[Abstract]:Objective to evaluate the safety and efficacy of atheromatous pseudo-occlusion (APO) in the treatment of internal carotid artery pseudoocclusion. Methods the data of 32 patients with carotid artery stenosis who received indirect carotid endarterectomy from December 2011 to June 2016 in Zhongshan Hospital affiliated to Fudan University were retrospectively analyzed. The study group consisted of 32 APO patients and the control group 124 patients with severe stenosis (70%). The primary and secondary complications, recurrence rate, restenosis rate and mortality rate of ipsilateral ischemic stroke were compared between the two groups during perioperative period. Results Myocardial infarction occurred in 1 case (3.1%) in the perioperative group, no ischemic stroke, cerebral hemorrhage and death occurred in the control group, and ischemic stroke occurred in 2 cases (1.4%), myocardial infarction in 6 cases (4.2%) and death in 1 case (0.7%) in the control group. In the control group, incision bleeding occurred in 1 case (3.1%), pulmonary infection in 2 cases (6.3%), hyperperfusion syndrome in 2 cases (6.3%), incision bleeding in 3 cases (2.1%), wound infection in 2 cases (1.4%), pulmonary infection in 4 cases (2.8%), cranial nerve injury in 2 cases (1.4%), hyperperfusion syndrome in 2 cases (1.4%). The average follow-up period was (35.3 卤17.5) months. One case (3.1%) in APO group had restenosis in ipsilateral ischemic stroke (12.5%) and 3 cases (9.4%) died of non-neurological diseases. In the control group, 8 cases (5.6%) had ipsilateral ischemic stroke recurrence, 9 cases (6.3%) had restenosis, 8 cases (5.6%) died. There was no significant difference in the recurrence rate restenosis rate and mortality rate of ipsilateral ischemic stroke between the two groups during perioperative period. Conclusion carotid endarterectomy is safe and effective in APO patients, and the perioperative and follow-up results are satisfactory.
【作者单位】：复旦大学附属中山医院血管外科-复旦大学血管外科研究所;
【基金】：国家自然科学基金(81570433) 上海市科委基金(14411962300)~~
【分类号】：R654.3

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