复合手术在颈动脉狭窄病变治疗中的初步应用

目的探讨颈动脉内膜切除术（CEA）联合其他术式（一站式复合手术）在治疗复杂性颈动脉狭窄病变中的临床意义。方法回顾性分析2010年3月-2013年10月因复杂缺血性颈动脉病变（包括颈动脉颅外段多处重度狭窄、单支颈动脉颅外段串联狭窄、支架内再狭窄、颈总动脉或颈内动脉完全闭塞）在首都医科大学宣武医院和山东省聊城市人民医院行一站式复合手术的10例患者的临床资料。复合手术方式分为3类，①病变侧CEA＋支架置入术；②颈动脉直视下支架置入术；③CEA＋透视下球囊导管取栓术。结果①2例接受CEA＋支架置入术的患者，术后影像学检查示闭塞或重度狭窄的血管管腔狭窄消失、血运恢复，头晕、肢体麻木、乏力、黑蒙等症状明显改善；②2例接受颈动脉直视下支架置入术的患者，术后影像学检查示狭窄的血管重新成形，血运良好，患者头痛、头晕等症状得以改善或未再加重；③6例接受CEA＋透视下球囊导管取栓术的患者，术后影像学检查示闭塞或重度狭窄的颈动脉开通、血运恢复，患者一侧肢体乏力、头晕、发作性头痛等症状得以缓解或未再加重。④随访患者6～24个月，影像学复查显示无再狭窄发生，再通血管血流通畅，颅内血供较术前明显改善。结论一站式复合手术可有效解除颈动脉分又过高或斑块远端过高、颈动脉串联样狭窄、颈内动脉合并颈总动脉狭窄、支架术后再狭窄等单一传统手术无法完成的复杂的狭窄性颈动脉病变。

Preliminary application of one-step hybrid operation in the treatment of carotid artery stenosis

Objective To investigate the clinical significance of carotid endarterectomy （CEA） in combination with other surgical procedures （one-step hybrid operation ） in the treatment of complex isehcmic eerebrovascular disease. Methods The clinical data of lO patients with complex ischemie eerebrovaseular diseases （including multivessel severe extracranial carotid stenosis, tandem stenosis of single extracranial carotid, in-stent restenosis, and complete occlusion of common carotid artery or internal carotid artery） treated in Beijing Xuanwu Hospital, Capital Medical University and Liaocheng People＇s Hospital, Shandong Province from March 2010 to October 2013 were analyzed retrospectively. The one-step hybrid operations were divided into three categories ： CEA ＋ carotid artery stenting （CAS） on the lesion side, CAS under direct visual control, and CEA ＋ received CEA ＋ CAS. Their imaging examinations stenosis of the lumen disappeared and blood flow Forgarty thrombectomy. Results （~）Two patients after procedure showed that the occlusion or severe was restored. Their dizziness, numbness, fatigue, amaurosis and other symptoms were improved.②Two patients received CAS under direct visual control. Their imaging examinations after procedure showed that the stenotic vessels returned to normal, and the blood supply was better. Their headache, dizziness and other symptoms were improved or did not further aggravate.③Six patients received CEA ＋ Forgarty thrombectomy. Their imaging examinations afterprocedure showed that the occlusion or severely stenotic carotid arteries were patent and the blood supply was restored. The limb weakness on one side, dizziness, paroxysmal headache and other symptoms were relieved or did not further aggravate. ④The patients were followed up for 6 to 18 months, and their imaging examinations showed that no restenosis occurred. The blood flow was patent and the intracranial blood supply was improved significantly compared with preprocedure imaging. Conclusion One-step hybrid operation may effectively relieve the complex stenotie carotid artery lesions that single traditional surgery can not complete, including too high carotid bifurcation or remote plaque, tandem stenosis in carotid artery, internal carotid artery with common carotid artery stenosis, and restenosis after stenting.