颈动脉瘤的外科治疗

目的探讨颈动脉瘤的外科治疗。方法回顾性分析2005年8月—2010年5月收治的16例颈动脉瘤患者的临床资料。发病至入院时间平均(31.0±0.7)个月。1例为双侧发病,15例患者为单侧发病;发病部位颈总动脉5例,颈内动脉9例,颈外动脉2例。7例患者无明显临床症状,5例伴有不同程度神经压迫症状,4例患者颈部外伤后出现颈部包块就诊。所有患者均行外科手术或血管腔内治疗。结果 16例患者均一期手术成功,无手术死亡。其中9例行外科手术,7例行血管腔内治疗。术后随访11例,随访时间平均(23.3±0.7)个月。超声检查:5例移植大隐静脉血管通畅;4例行覆膜支架患者例颈动脉通畅,瘤腔完全闭塞;2例支架内血栓形成,颈动脉闭塞,但无临床症状,未再外科干预。结论颈动脉瘤发生率虽低,但潜在风险高,一旦确诊,应积极治疗。开放手术疗效确切,血管腔内治疗微创,两者均为有效的外科治疗手段。

Surgical treatment of carotid aneurysm

Objective:To discuss surgical treatment of carotid aneurysm.
Methods:The clinical data of 16 patients with carotid aneurysm treated in our department from August 2005 to May 2010 were retrospectively analyzed. The average interval from onset to hospitalization  was (31.0 ± 0.7) months. Of the patients, 15 cases were unilateral aneurysm and 1 case was bilateral aneurysm. The lesions were respectively located in common carotid artery (5 cases), internal carotid artery (9 cases) and external carotid artery (2 cases). The clinical findings of the patients included asymptomatic lesions in 7 cases, varying degrees of nerve compression in 5 cases and cervical mass after injury in 4 cases. All the patients underwent open surgery or endovascular treatment.
Results:One-stage operation was successfully performed in all patients that included 9 cases of surgical resection and 7 cases of endovascular therapy, and no operative death occurred. Eleven patients were followed up for an average period of (23.3 ± 0.7) months. Ultrasonic evaluation showed that all grafts were patent in the 5 cases undergoing great saphenous vein grafting; in the 4 other cases with placement of covered stents, the carotid arteries were patent and the aneurysms were completely occluded. In-stent thrombosis and carotid artery occlusion were detected in another 2 cases, but no further surgical treatment was performed because they caused no obvious symptoms.
Conclusions:The incidence of carotid aneurysm is relatively low, but it has high risk potential. Thus, it should be aggressively treated once diagnosed. Open surgery has obvious curative effect, while endovascular treatment is minimally invasive, and both procedures are effective treatments for carotid aneurysm.