颈动脉内膜切除术治疗颈动脉重度狭窄的临床效果分析

【摘要】目的探讨颈动脉内膜切除术（CEA）对治疗颈动脉重度狭窄的临床效果。方法回顾性分析97例重度颈动脉狭窄行CEA治疗患者的临床资料，病例均为症状性狭窄，伴有溃疡斑块。结果97例患者手术均顺利进行，术中荧光造影均显示狭窄明显解除，血流通畅，术中阻断时间为20~30 min；术后有并发症，其中颈部切口周围轻度肿胀青紫5例，血肿形成3例，声音嘶哑4例，耳后皮肤麻木5例，同侧症状性脑梗死1例，无症状性脑梗死3例，过度灌注脑出血1例，局部血栓导致颈动脉闭塞2例，无严重致残及死亡病例。术后随访3~30个月，再狭窄3例，1例行球囊扩张术，其他2例继续随访中。结论CEA是治疗颈动脉狭窄安全的、有效的、可靠的手术方式，也是唯一可以达到去除动脉粥样硬化斑块，并能完全重建正常管腔和血流的方法。

Abstract： Objective To explore the clinical effects of carotid endarterectomy in the treatment of severe carotid stenosis. Methods The clinical data of 97 patients with severe carotid stenosis treated with CEA were analyzed retrospectively. All cases were symptomatic stenosis with ulcerative plaque. Results All the 97 patients were operated smoothly. The intraoperative fluorescein angiography showed that the stenosis was obviously relieved and the blood flow was unobstructed. The intraoperative blocking time was 20-30 minutes. There were postoperative complications, including mild swelling and cyanosis around the neck incision in 5, hematoma formation in 3, hoarseness in 4, postauricular skin numbness in 5, ipsilateral symptomatic cerebral infarction in 1, asymptomatic cerebral infarction in 3, excessive perfusion cerebral hemorrhage in 1, local thrombosis leading to carotid artery occlusion in 2, and no serious disability or death. The patients were followed up for 3-30 months, 3 were restenosis, 1 underwent balloon dilatation, and the other 2 were still followed up. Conclusion CEA is a safe and effective surgical method for carotid stenosis and the only way to remove atherosclerotic plaque and reconstruct normal lumen and blood flow.