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目的总结颈动脉内膜剥脱术防治颈动脉硬化性狭窄引起的缺血性脑卒中的临床应用。方法回顾性分析2001年11月～2012年1月间对147侧(139例)颈动脉狭窄病变实施内膜剥脱术治疗的临床资料。结果本组中,87%的患者采用颈丛麻醉,92%的患者颈动脉内膜剥脱后应用补片血管成形,11例患者术中放置临时性转流管,2例患者为颈动脉支架失败后改行颈动脉内膜剥脱术(CEA)。术后轻度神经损伤7例,占4.8%;1例于术后3天出现偏瘫,占0.7%;全组无围术期死亡病例。临床随访123例,随访率为88.5%,平均随访39±4个月。术后患者脑缺血症状消失或明显改善97例,占66%;症状改善、好转者19例,占12.9%;术后颈动脉再狭窄发生24例(均<50%),占16.3%。结论颈动脉内膜剥脱术疗效肯定,值得推广应用。
Objective To summarize the clinical application of carotid endarterectomy in the prevention and treatment of ischemic stroke caused by carotid artery stenosis. Methods The clinical data of 147 cases (139 cases) of carotid stenosis treated with endarterectomy were retrospectively analyzed from November 2001 to January 2012. Results In this study, 87% of the patients underwent cervical plexus anesthesia. In 92% of patients, patch angioplasty was performed after carotid endarterectomy. In the group of 11 patients, temporary tampons were placed intraoperatively and two patients failed to receive carotid stenting After the conversion of carotid endarterectomy (CEA). Postoperative mild nerve injury in 7 cases, accounting for 4.8%; 1 case of hemiplegia after 3 days, accounting for 0.7%; no perioperative deaths in the whole group. Clinical follow-up of 123 cases, the follow-up rate was 88.5%, with an average follow-up of 39 ± 4 months. 97 cases (66%) had symptoms of cerebral ischemia after operation, 19 cases (12.9%) improved symptoms, 24 cases (all <50%) of carotid restenosis occurred after operation, accounting for 16.3%. Conclusion Carotid endarterectomy is effective and worthy of promotion.