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目的总结颈动脉内膜切除术(carotid endarterectomy,CEA)治疗颈动脉狭窄的临床经验及疗效。方法 1998年10月-2010年1月,对215例颈动脉狭窄患者行CEA治疗。男140例,女75例;年龄51～88岁,平均66岁。术前有短暂性脑缺血发作(transient ischemic attack,TIA)127例,有脑梗死病史31例。患者术前均行选择性颈动脉造影检查和/或CT血管造影明确颈动脉狭窄,狭窄程度均>80%,同时伴对侧颈动脉狭窄或闭塞45例。合并冠状动脉病变96例,其中25例同期行冠状动脉搭桥术;合并外周血管病变43例并同期处理。结果术后155例获随访,随访时间6～72个月。其中148例术前临床症状均改善。术后1周内2例出现脑出血,1例经保守治疗后好转出院,1例死亡。术中1例舌下神经损伤、4例面神经下颌缘支损伤者,均未作特殊治疗。术后7～24个月25例手术部位再狭窄,狭窄程度均<25%且患者无TIA症状,未作特殊处理。1例随访3年时死于急性心肌梗死,其余患者均病情稳定。结论 CEA是治疗颈内动脉狭窄的一种安全、有效方法。
Objective To summarize the clinical experience and therapeutic effect of carotid endarterectomy (CEA) on carotid artery stenosis. Methods From October 1998 to January 2010, 215 patients with carotid stenosis underwent CEA. 140 males and 75 females; aged 51 to 88 years, mean 66 years. Preoperative transient ischemic attack (transient ischemic attack, TIA) in 127 cases, a history of cerebral infarction in 31 cases. Patients underwent preoperative selective carotid angiography and / or CT angiography clear carotid stenosis, stenosis were> 80%, accompanied by contralateral carotid artery stenosis or occlusion in 45 cases. A total of 96 patients with coronary artery disease, including 25 cases of coronary artery bypass grafting during the same period; combined peripheral vascular disease in 43 cases and treated at the same period. Results 155 cases were followed up for 6 to 72 months. 148 cases of preoperative clinical symptoms were improved. One case had intracerebral hemorrhage within one week after operation, one case was discharged after conservative treatment and one case died. One case of hypoglossal nerve injury, 4 cases of facial nerve injury caused by mandibular margins, were not for special treatment. After operation 7 to 24 months 25 cases of surgical site restenosis, stenosis were <25% and the patient without TIA symptoms, without special treatment. One patient died of acute myocardial infarction at 3 years of follow-up. The remaining patients were stable. Conclusion CEA is a safe and effective method for the treatment of carotid artery stenosis.