颈动脉内膜剥脱术治疗颈动脉狭窄58例临床分析

目的 评估颈动脉内膜剥脱术治疗颅外颈动脉狭窄的疗效,并探讨经颅多普勒超声(transcranial Doppler,TCD)的价值. 方法回顾性分析2002年1月至2008年12月采用颈动脉内膜剥脱术治疗的58例颅外颈动脉狭窄的资料.40例伴有不同程度的脑缺血症状,18例无明显症状.颈动脉狭窄程度均在70%以上.41例行内膜剥脱后动脉单纯缝合,9例采用人工材料(涤纶)补片成形,8例行自体静脉补片成形.32例在TCD的监测下完成,26例没有采用TCD监测,28例则采用临时转流管. 结果手术成功率为100%,无死亡率.术前有腩缺血症状的40例患者中,术后大多数患者有不同程度的恢复.未采用TCD组患者5例(19.2%)术后出现脑血流过度灌注.采用TCD者未发现过度灌注的并发症.53例患者获随访,随访率为91.4%;随访时间为15～86个月,平均42.5个月.死亡5例.3例出现术后再狭窄(5.7%),其中2例接受颈动脉支架成形术,1例仍在观察随访中.结论 颈动脉内膜剥脱术治疗颅外颈动脉狭窄是一种安全、有效的措施;TCD监测对于转流管的选择提供重要依据,并对预防术后过度脑灌注具有指导作用.

The value of transcranial Doppler in carotid endarterectomy: report of 58 cases

Objective To evaluate the role of transcranial Doppler (TCD) in carotid endarterectomy and the effect of carotid endarterectomy on extracranial carotid artery stenosis.Methods From January 2002 to December 2008, fifty eight patients (40 males and 18 females)with mean age of 64.5 years were treated in our hospital. Of these patients, forty had symptoms of cerebral ischemia, eighteen were asymptomatic. All the patients had 70% and up carotid artery stenosis. Forty one patients underwent simple suture closure of the arterial incision while nine patients had angioplasty with arterial patch (polyester) and eight with autologous great saphenous vein. TCD monitoring was used in the surgery of 32 patients excluding two patients using arterial shunt. Results Surgery was successful in all 58 cases except for deflected tongue-protrusion in five patients after operation, of which three recovered conservatively and two recovered after administration of cortical steroids for two weeks. Cerebral ischemic symptoms improved to a certain degree in all the 40 preoperative symptomatic patients. Cerebral hyperperfusion occurred in five of no TCD-monitoring patients ( 19.2% ), no hyperperfusion was found in TCD-monitored patients. Fifty three patients were followed up for a mean time of 42.5 months. Five patients died and three patients had carotid artery restenosis, of which two underwent PTA and stenting, one is still under surveillance.Conclusions Carotid endarterectomy is a safe and effective procedure for treating extracranial carotid artery stenosis. TCD monitoring is valuable for determining the use of arterial shunt and preventing postoperative cerebral hyperperfusion.