血管补片成形对颈动脉内膜剥脱术后再狭窄的预防作用研究

发布时间：2019-07-09 13:41

【摘要】：目的:研究血管补片成形对颈动脉内膜剥脱术(carotid endarterectomy,CEA)术后再狭窄的预防作用。方法:收集新疆医科大学附属中医医院72位均接受颈动脉内膜剥脱术的颈动脉狭窄患者,其中6人行双侧颈动脉内膜剥脱术,共记78例次手术。以术前颈内动脉超声测内径(㩳4.0mm放置补片)和术中具体观察情况作为分组依据,其中颈动脉内膜剥脱后用血管补片成形40例(实验组),颈动脉内膜剥脱后血管直接缝合38例(对照组),进行回顾性分析。以两组术前基本资料,术中平均颈动脉阻断时间,平均手术时间,术后30天内并发症,术后近远期颈动脉再狭窄程度及例数为主要的观察指标进行对比分析。结果:两组术前基本资料比较无显著性差异(P㧐0.05),具有可比性。术后30天并发症中高灌注综合征(CHS)发生率上,补片组高于非补片组,差异有统计学意义(P0.05)。补片组在平均颈动脉阻断时间和平均手术时间明显长于非补片组,两组比较有显著性差异(P0.05)。78例随访均为2年以上,无一例失访,其中6个月内两组通畅率差异无统计学意义(P㧐0.05)。6~12个月两组通畅率差异有统计学意义(P0.05),补片组通畅率优于非补片组。㧐12~24个月时,狭窄复发的例数和程度上,非补片组明显高于补片组,两组通畅率差异有统计学意义(P0.05)。结论:术中应用血管补片成形扩大血管腔在预防颈动脉内膜剥脱术后再狭窄上具有明显作用,能显著提高中远期颈动脉通畅程度。同时补片成形具有一些缺点,建议根据具体情况尽可能使用。
[Abstract]:Objective: To study the preventive effect of vascular patch on the restenosis after carotid endarterectomy (CEA). Methods:72 patients with carotid artery stenosis underwent carotid endarterectomy in the 72-position of the Affiliated Chinese Medicine Hospital of Xinjiang Medical University, of which,6-person bilateral carotid endarterectomy was performed, and 78 cases were recorded. The internal diameter of the internal carotid artery (? In this paper,40 cases (experimental group) and 38 cases (control group) were directly sutured after carotid endarterectomy, and 38 cases (control group) were directly sutured after carotid endarterectomy. The average carotid artery occlusion time, mean operative time, complications during 30 days after operation, and the degree and number of carotid re-stenosis in the near-long-term postoperative carotid artery were compared and analyzed in two groups. Results: There was no significant difference between the two groups before and after operation (P? 0.05). The incidence of high-perfusion syndrome (CHS) in 30-day postoperative complications was higher than that in non-mesh group (P0.05). The mean carotid block time and the mean operative time of the patch group were significantly longer than that of the non-patch group, and there was a significant difference between the two groups (P0.05).78 cases were followed up for more than 2 years and none of them were lost to follow-up. There was no significant difference in the patency rate of the two groups in 6 months (P? 0.05). The patency rate of the two groups was statistically significant between 6 and 12 months (P0.05). The patency rate of the patch was superior to that of the non-mesh group. In the 12 ~ 24 months, the number and extent of the recurrence of the stenosis was significantly higher than that of the patch group, and there was a significant difference between the two groups (P0.05). Conclusion: The use of vascular patch-forming to enlarge the vessel cavity in the prevention of carotid endarterectomy has a significant effect on the prevention of carotid endarterectomy, and the degree of long-term and long-term carotid artery patency can be significantly improved. While the mesh forming has some disadvantages, it is suggested to use as much as possible depending on the particular situation.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.12

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