两种颈动脉内膜剥脱术式治疗颈动脉狭窄的临床分析

目的 分析翻转式颈动脉内膜剥脱术(eCEA)及颈动脉内膜剥脱+人工血管补片成形术(pCEA)治疗颅外段颈动脉狭窄患者的疗效及治疗成本。方法 回顾性分析北京协和医院血管外科2009年10月至2012年10月行颈动脉内膜剥脱术的颈动脉狭窄患者资料,所有患者按手术方式不同分为eCEA组和pCEA组。结果 两组患者性别、年龄、危险因素、病变狭窄程度及双侧病变例数比较,差异均无统计学意义(P＞0.05)。eCEA组在使用转流管、抗生素例数、手术时间、住院天数及住院费用上均低于pCEA组,差异具有统计学意义(P＜0.05)。两组治疗效果、并发症、手术相关死亡、术后再狭窄及术后同侧脑卒中比较,差异均无统计学意义(P＞0.05)。结论 两种手术方式均安全、有效,eCEA术式在治疗成本上优于pCEA术式,可作为首选术式。

Clinical Analysis of Two Carotid Endarterectomy Procedures in Treating Carotid Artery Stenosis

Objective To analyze the effectiveness and costs of the eversion carotid endarterectomy(eCEA)and the carotid endarterectomy with patch angioplasty(pCEA)in treating carotid artery stenosis.Methods Patients with carotid artery stenosis who underwent the carotid endarterectomy in the vascular surgery department of Peking Union Medical College Hospital from October 2009 to October 2012 were enrolled in this study.According to the two different surgical procedures,the patients were divided into eCEA group and pCEA group.Results The two groups were not significantly different in terms of gender,age,risk factors,stenosis degree of carotid artery,and the ratio of bilateral lesions(all P＞0.05).The ratio of shunt and antibiotics application,operative time,hospitalization cost,and length of hospital stay in the eCEA group were significantly lower than those in pCEA group(P＜0.05).The therapeutic effectiveness,complications,surgery-related death,restenosis,and ipsilateral stroke were not significantly different between these two groups(P＞0.05).Conclusion Both surgical procedures are safe and effective in treating the carotid artery stenosis;however,eCEA has lower cost when compared with pCEA and therefore can be used as the first choice.