颈动脉内膜切除术治疗颈动脉狭窄的有效性及安全性评估

目的探讨应用颈动脉内膜切除术（CEA）治疗颈动脉狭窄患者的有效性和安全性,评估影响术后围手术期卒中和死亡的相关因素。方法回顾性分析2000年1月———2011年9月首都医科大学宣武医院采用CEA治疗的颈动脉狭窄患者的临床资料,共302例（对其中6例分期行双侧手术,每例按2例单独病例进行统计,共计308例）。分析手术的安全性、有效性,采用单因素及多因素Logistic回归分析,分析影响术后30 d内卒中和死亡的相关因素。结果①308例中,255例单纯狭窄的病例手术获得全部成功,53例完全闭塞或近全闭塞的患者中,5例血管再通失败。手术成功率为98.4%。②术后30 d内,卒中和死亡的患者有14例（4.5%）,其中,死亡4例（1.3%）,脑梗死7例（2.3%）,脑出血3例（1.0%）;脑神经损伤的有10例（3.3%）,心肌梗死2例（0.6%）,心绞痛2例（0.6%）,心力衰竭2例（0.6%）,心律失常8例（2.6%）,术后出现暂时性的精神症状的有20例（6.5%）。③299例获≥1个月的随访,平均25.7个月。11例（3.7%）发生再狭窄,其中10例（3.3%）发生时间为1年左右。有2例（0.7%）术后出现短暂性脑缺血（TIA）症状,均为再狭窄的患者。④单因素分析结果显示,术后改良Rankin评分（mRS）≥3分者术后30d内卒中和死亡的发生率明显增高（P〈0.05）;多因素Logistic回归分析显示,吸烟（OR=0.198,95%CI：1.237～14.676）及mRS评分≥3分者（OR=11.707,95%CI：3.101～44.193）是导致术后30 d内卒中和死亡的独立影响因素。结论 CEA能有效地防治颈动脉狭窄导致的卒中发作风险。吸烟和术前mRS评分≥3可以增加CEA的危险性。

Efficacy and safety assessment of carotid endarterectomy for carotid stenosis

Objective To investigate the efficacy and safety of using carotid endarterectomy(CEA) in the treatment of patients with carotid stenosis and the effect of related factors on perioperative complications.Methods The clinical data of 302 patients with carotid stenosis(6 of them underwent bilateral operation at two different stages,each patient was calculated as 2,therefore,there were a total of 308 patients) treated with CEA in Xuanwu Hospital,Capital Medical University from January 2000 to September 2011 were analyzed retrospectively.The safety and efficacy of the operation was analyzed.The univariate and multivariate logistic regression analyses were used to analyze the related factors for affecting stroke and death within 30 days after operation.Results ①Among the 308 patients,255 patients with simple stenosis were all successful in the operations.Of the 53 patients with complete or nearly complete occlusion,5 were failed for recanalizations.The surgical success rate was 98.4%.②14 patients(4.5%) had stroke or died within 30 days after operation,among them 4 died(1.3%),7 had cerebral infarction(2.3%),3 had cerebral hemorrhage(1.0%);10 had cranial nerve injury(3.3%),2 had myocardial infarction(0.6%),2 had angina pectoris(0.6%),2 had heart failure(0.6%),8 had arrhythmia(2.6%),and 20(6.5%) had temporary mental symptoms.③A total of 299 patients were followed up for ≥1 month(mean 25.7 months).Eleven patients(3.7%) had restenosis,and 10 of them occurred at about 1 year.Two patients(0.7%) had transient ischemic attack(TIA),and both them had restenosis.④The univariate analysis results showed that the patients whose mRS ≥ 3 the early postoperative complications increased significantly(P<0.05);the multivariate logistic regression analysis showed that smoking(OR=0.198,95%CI 1.237-14.676) and mRS ≥ 3(OR=11.707,95%CI 3.101-44.193) were the independent influencing factors for stroke and death within 30 days after operation.Conclusion CEA may effectively prevent and treat the carotid artery stenosis caused stroke.Smoking and mRS ≥ 3 may increase the surgical risk of patients.