颈内动脉狭窄的手术治疗

目的总结颈内动脉内膜切除术(CEA)治疗颈内动脉重度狭窄的临床经验。方法回顾性分析1998年10月~2006年10月在我科行CEA的95例患者(97次)的临床资料,97次均为初次手术,无二次手术;65例术前有短暂性脑缺血发作(TIA),21例术前曾患脑梗死。所有患者术前经选择性颈动脉造影证实狭窄程度均大于70%,其中50例狭窄程度大于95%,35例对侧伴有颈动脉狭窄或闭塞。颈动脉分叉位置平第2颈椎水平5例,第2颈椎水平以上1例。43例患者术前行冠状动脉造影证实合并冠心病,其中18例同期行冠状动脉搭桥术。结果所有术前有临床症状的患者术后有较明显改善,表现为TIA消失、记忆力明显好转和语言障碍恢复等;1例患者术后出现舌下神经损伤,该患者颈动脉分叉位于第2颈椎水平以上。术后随访6~60个月,1例在随访期间因心脏病死亡,其余患者病情稳定。结论CEA是治疗颈内动脉重度狭窄的安全有效的方法。

Treating severe stenosis of internal carotid artery with carotid endarterectomy

Objective To explore the effective and safety of carotid endarterectomy (CEA) in the treatment of severe stenosis of internal carotid artery. Methods The clinical data of 95 patients with internal carotid artery stenosis and treated by CEA in our hospital from October 1998 to October 2006 were retrospectively analyzed. Transient ischemic attack (TIA) was found in 65 patients and cerebral infarction in 21 patients before operations. Diagnoses were confirmed by selective angiography, and >70% stenosis of internal carotid artery was found in all patients and >95% stenosis was found in 50 patients. Stenosis or occlusion of the contralateral carotid artery was also found in 35 patients. Coronary artery stenosis was confirmed in 43 patients with preoperative coronary angiography. CEA and coronary artery bypass grafting (CABG) were simultaneously performed in 18 patients. Results After the operation, the clinical symptoms significantly improved in all patients. One case experienced hypoglossal nerve injury. One patient died of heart attack during follow-up. Conclusion CEA is an effective and safe treatment for severe stenosis of internal carotid artery.