颈动脉硬化内膜剥脱术预防脑梗死94例分析

目的探讨颈动脉硬化内膜剥脱术预防脑梗死的临床效果。方法1996~2004年北京大学人民医院共治疗颈动脉粥样硬化性狭窄或闭塞94例。行单纯颈动脉硬化内膜剥脱者84例93次,其中在颈动脉转流管保护下完成64例73次。对于完全闭塞的13例病人行硬化内膜剥脱和取栓术。结果13例完全闭塞的颈动脉病人2例部分再通,10例获完全再通,1例未能再通。但1例获得完全再通后5h发现脑出血死亡。另1例拔除气管插管时并发气管痉挛未能及时插管导致脑缺氧时间过长病人最后呈植物状态。除1例术后早期出现一侧上肢稍麻木外,其他颈动脉狭窄者无论转流或非转流下行内膜剥脱者均未发生脑缺血并发症。随访发现1例行内膜剥脱术后局部再次狭窄20%左右。结论颈动脉硬化内膜剥脱术为一种安全的预防脑梗死方法,颈动脉转流能提高颈动脉内膜剥脱术的安全性。

Prevention of cerebral infarction through carotid endarterectomy: a report of 94 cases

Objective To sum up the experience of carotid endarterectomy (CEA).Methods Ninety-four cases of stenosis or occlusion of carotid artery (CA) were treated from 1996 to 2004 in Affiliated People Hospital of Beijing University.CEA was used in 93 lesions of 84 cases.Among them,73 lesions of 64 cases were performed under shunting.Combined CEA and thrombectomy of CA due to complete occlusion was carried out in 13 cases.Results In 13 cases of complete occlusion of CA,complete recanalization and partial recanalization were reached in 9 and 3 cases respectively through combined CEA and thrombectomy.And the occluded CA was not recanalized in one case.One case died of cerebral haemorrhage in 5 hours after recanalization.Another case was complicated of tracheal spasm during extubation resulted in botanic status.No ischemic cerebral complication was found for CEA with or without shunting except that one case complicated of numbness of contralateral upper limb.20% of restenosis of post-CEA was found in 1 case.Conclusion CEA is a kind of safe method for prevention of cerebral infarction. Shunting could improve the reliability of CEA.