外翻式颈动脉内膜切除术治疗症状性颈动脉狭窄32例临床分析

目的 探讨应用外翻式颈动脉内膜切除术治疗症状性颈动脉狭窄对缺血性脑卒中的预防.方法 静吸复合麻醉下对32例症状性颈动脉狭窄患者行外翻式颈动脉内膜切除术.术中行全程经颅超声多普勒监测.结果 本组32例患者均成功完成外翻式颈动脉内膜切除术.17例因短暂性脑缺血发作(TIA)入院患者未再出现TIA发作,其他患者原有症状有不同程度好转或消失.患者术后72 h内发生TIA,24 h多次CT血管造影(CTA)检查无梗死灶出现,经小剂量尿激酶治疗后恢复.2例因切口肿胀出现严重气管移位,经鼻气管插管后,患者顺利渡过水肿期.4例患者出现头痛,经脱水药物治疗后均在术后2～3 d缓解.7例患者术后出现不同程度声音嘶哑,神经营养药物治疗1个月后恢复.无其他严重并发症发生.术后随访6个月,CTA复查无一例颈动脉再狭窄出现.结论 外翻式颈动脉内膜切除术是颈动脉狭窄的有效治疗方法,可有效预防缺血性脑卒中的发生.

Clinical analysis of 32 patients with symptomatic carotid stenosis treated by eversion carotid endarterectomy

Objective To review the experience and early clinical results of eversion carotid endartotectomy (eCEA) in treatment of patients with symptomatic carotid stenosis. Methods eCEA were performed on 32 patients who suffered from the extracranial carotid stonosis. The treatment results were retrospectively reviewed. Results Thirty-two patients were successfully treated with eCEA. The symptom in 17 patients with transient ischemia attach (TIA) admitted to hospital did not recurrence, the other original symptoms of the patients had different degrees of improvement or disappeared. Two patients had TIA during 72 h after surgery, but 24 h repeatedly CTA examination without infarcts oecurring, and recovered after the treatment of small doses of urokinase. Two cases of severe swelling appeared tracheal shift incision, and went smoothly through edema by treatment of tracheal intubatian. In 4 patients headache reliefed in 2-3 d after medical treatment of the dehydration. Seven patients appeared different degree of hoarseness, and got recovery through neurotrophic medication for 1 month. No other serious complication occurred. Follow-up by 6 months, no CTA carotid artery stenosis appeared again. Conclusion eCEA is an effective method to treat symptomatic carotid stenosis.