颈动脉内膜切除术在“真实世界”的争议与思考
发布时间：2019-04-23 21:08
【摘要】：颈动脉内膜切除术(CEA)是治疗颈动脉狭窄、预防脑卒中的"金标准",国外已相对成熟,国内虽起步晚,但发展迅速。笔者在CEA的推广过程中,发现很多同道虽然可基本掌握手术技巧,但在概念理解、术式选择、技术理念、并发症防治等方面与国际先进水平仍存差距。很多同道在实际工作中仍在纠结于以下问题:CEA是切斑块还是切内膜?如何切除?切除的部位?切除到何种程度?是否需加做血管裁剪和吻合口成形?本文针对CEA在"真实世界"中的四则争议——概念存疑、术式纠结、理念差异和技术困惑——进行概括并提出个人思考,同时与各位读者分享本领域的最新进展。
[Abstract]:Carotid endarterectomy (CEA) is a "golden standard" for the treatment of carotid stenosis and the prevention of stroke. It has been relatively mature abroad. Although it started late at home, it has developed rapidly. In the process of popularizing CEA, it is found that although many of them can master basic surgical techniques, there is still a gap between them in terms of understanding of concepts, choice of surgical procedures, technical concepts, prevention and treatment of complications and so on. Many colleagues are still struggling with the following questions in practical work: is CEA cutting plaques or endomembranes? How? The excised part? To what extent? Is there a need for vascular clipping and anastomosis? In this paper, four controversies of CEA in the "real world"-doubt of concept, entanglement of operation, difference of concept and technical confusion-are summarized and personal thinking is put forward. At the same time, the latest progress in this field is shared with readers.
【作者单位】： 第二军医大学长征医院血管外科;
【基金】：上海高校特聘教授(东方学者)跟踪计划基金(GZ2016008) 上海领军人才基金(035) 国家自然科学基金(81570440) 上海市科委2016年度医学引导类(中、西医)科技支撑项目基金(16411966500)~~
【分类号】：R651.12
[Abstract]:Carotid endarterectomy (CEA) is a "golden standard" for the treatment of carotid stenosis and the prevention of stroke. It has been relatively mature abroad. Although it started late at home, it has developed rapidly. In the process of popularizing CEA, it is found that although many of them can master basic surgical techniques, there is still a gap between them in terms of understanding of concepts, choice of surgical procedures, technical concepts, prevention and treatment of complications and so on. Many colleagues are still struggling with the following questions in practical work: is CEA cutting plaques or endomembranes? How? The excised part? To what extent? Is there a need for vascular clipping and anastomosis? In this paper, four controversies of CEA in the "real world"-doubt of concept, entanglement of operation, difference of concept and technical confusion-are summarized and personal thinking is put forward. At the same time, the latest progress in this field is shared with readers.
【作者单位】： 第二军医大学长征医院血管外科;
【基金】：上海高校特聘教授(东方学者)跟踪计划基金(GZ2016008) 上海领军人才基金(035) 国家自然科学基金(81570440) 上海市科委2016年度医学引导类(中、西医)科技支撑项目基金(16411966500)~~
【分类号】：R651.12
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