颈动脉内膜剥脱术治疗高龄颈动脉狭窄患者的安全性和有效性分析

目的分析颈动脉内膜剥脱术（cEA）治疗高龄（≥75岁）颅外段颈动脉狭窄患者的疗效及安全性。方法回顾性分析北京协和医院血管外科2009年10月至2012年10月期间行CEA治疗的312例颈动脉狭窄患者的临床资料，分析CEA治疗高龄颈动脉狭窄患者的危险因素，探讨围手术期并发症的预防措施。结果本研究共纳入39例患者，所有手术过程顺利，随访时间为（22．18±8．71）个月。其中男33例（84．6％），女6例（15．4％）；中位年龄77岁（75～82岁）；双侧病变患者11例（28．2％），无症状患者7例（17．9％）；共施行39例次CEA，22例次（56．4％）采用颈动脉补片；16例次（41．0％）使用转流管；住院时间（17．38±5．39）d。1例患者（2．6％）术后第2天出现脑过度灌注综合征，1例患者（2．6％）术后15个月出现手术侧再狭窄，无围手术期死亡病例。结论在严格掌握手术适应证情况下，CEA是治疗高龄颈动脉狭窄患者安全而有效的方法。

Analysis on Effectiveness and Safety of The Carotid Endarterectomy in Treating Elderly Patients with Carotid Artery Stenosis

Objective To summarize the experience in treating the elderly patients （≥ 75 years old） with carotid artery stenosis, and to evaluate the efficacy and safety of the carotid endarterectomy （CEA）. Methods The datum of 312 cases with carotid artery stenosis and underwent the CEA in the vascular surgery department of Peking Union Medical College Hospital from October 2009 to October 2012 were retrospectively analized. The risk factors of the CEA in treating the elderly patients were analized, and the measures to prevent perioperative complications were discussed. Results Thirty-nine cases were brought into the research. The mean follow-up was （22. 18±8.71） months. Thirty-three cases （84. 6%） were male and 6 cases （15.4%） were female. The median age was 77 years old （75-82 years old）. Eleven cases （28. 2%） were with bilateral lesions, and 7 cases （17.9%） were asymptomatic. A total of 39 CEA procedures were successfully performed, 22 artificial vascular patches （56. 4%） and 16 shunts （41.0%） were used. The mean average hospital stay was （17.38±5.39） days. One case showed cerebral hyperperfusion syndrome in 2th day after operation, another 1 case was found ipsilateral restenosis in 15th month after operation. Conclusion CEA is a safe and effective measure in treating the elderly patients with carotid artery stenosis, if the the indications of surgery is performed strictly.