颈动脉内膜切除术治疗颅外颈内动脉重度狭窄近、远期疗效

目的　评价颈动脉内膜切除术治疗颅外颈内动脉重度狭窄近、远期疗效.方法　1993年5月至2000年6月,共20例患者在中山医院接受21次颈动脉内膜切除术.男性19例,女性1例,年龄47-76岁,平均64±9岁.其中缺血性中风患者7例,一过性脑缺血者11例,无神经症状者2例.所有患者均行术前颈动脉Duplex超声检查,19例同时行DSA检查,18例行MRA检查.狭窄度测定方法同NASCET.21侧手术的颈内动脉中,19侧狭窄≥70%,2侧狭窄60%-69%伴斑块溃疡.手术均采取颈丛麻醉,术中选择性地应用转流管和补片缝合.术后定期行超声检查和随访.结果　术后30天内无死亡和中风.围手术期有1例TIA和2例术后颅神经损伤.20例患者随访1-63月,平均31±20月.术后2年生存率和中风发生率为92.3%和0%,5年生存率和中风发生率为79.1%和12.5%.2例随访中超声检查发现手术侧颈内动脉50%-60%的再狭窄.结论　本组病例中,颈动脉内膜切除术治疗颅外颈内动脉重度狭窄取得了满意的围手术期结果和预防中风的远期疗效.

Early and late outcomes in patients with severe extracranial internal carotid stenosis undergoing carotid endarterectomy

Objective To determine the perioperative and late outcomes for carotid endarterectomy (CEA) in treatment of patients with high-grade stenotic lesions of the extracranial internal carotid artery. Methods Twenty patients underwent 21 CEAs at the Zhongshan Hospital between May 1993 and June 2000. They were 19 men and 1 woman, with a mean age of 64±9 years. Seven patients were performed for stroke, 11 for transient ischaemic attacks (TIAs) and 2 for asymptomatic disease. Duplex scan was the primary tool of evaluation prior to surgery. Perioperative digital subtraction angiography and magnetic resonance angiography were done for 19 and 18 patients, respectively. The percentage of stenosis was calculated using NASCET criteria. Of the 21 lesions operated, 19 had a stenosis of 70% or greater, 2 had ulcerative lesions with a stenosis ranging from 60% to 69%. All CEAs were performed under cervical block anaesthesia with selective intraoperative shunting and patch angioplasty. The patients were followed up regularly with duplex scan surveillance. Results There was no mortality or stroke during 30 days postoperatively. A TIA occurred in one patient and cranial nerve injury in 2 patients perioperatively. All patients were followed up for a mean interval of 31±20 months (range: 1-63 months). The 2-year survival rate and risk of stroke were 92.3% and 0%, respectively, and the 5-year survival rate and risk of stroke were 79.1% and 12.5%, respectively. Two asymptomatic recurrent stenoses ranging from 50% to 60% were detected on follow-up duplex scan. Conclusions For the patients in this study, CEA is associated with an acceptable perioperative outcome as well as a satisfactory long-term beneficial effect in stroke prevention.