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目的探讨应用颈动脉内膜切除术(CEA)治疗症状性颈动脉狭窄的早期疗效和体会。方法 40例症状性颈动脉狭窄行CEA手术的患者纳入本研究。所有病例均具有脑缺血的临床症状。全组均经颈部彩色多普勒成像、经颅多普勒超声初期筛查检出,9例、3例、28例分别应用增强磁共振血管成像、CT血管造影、数字减影血管造影确诊为颈动脉粥样斑块形成并颈动脉狭窄。40例颅外段颈动脉狭窄程度均≥70%,其中合并溃疡病变5例,一侧颈内动脉狭窄伴另一侧颈内动脉完全闭塞1例。患者全部行全身麻醉联合颈丛神经阻滞麻醉。术中全部放置动脉临时分流管,行颈动脉血管补片成形术32例。结果全组围手术期无死亡病例,脑缺血症状明显改善31例(77.5%),症状好转9例(22.5%)。术后并发高灌注综合征1例,血流动力学不稳定1例。症状性颈动脉狭窄围手术期并发症5.0%(符合美国AHA≤6%的标准)。40例均获随访,在术后6周及3个月复查双侧颈部血管超声,无1例血管再狭窄发生。结论 CEA是治疗症状性颈动脉狭窄安全且有效的方法。
Objective To investigate the early effect and experience of carotid endarterectomy (CEA) in the treatment of symptomatic carotid stenosis. Methods Forty patients with symptomatic carotid stenosis undergoing CEA surgery were enrolled in this study. All cases had clinical symptoms of cerebral ischemia. All the patients were diagnosed by color Doppler ultrasound and initial transcranial Doppler ultrasound examination. Nine cases, three cases and 28 cases were diagnosed by enhanced magnetic resonance angiography, CT angiography and digital subtraction angiography Carotid artery plaque formation and carotid artery stenosis. 40 cases of extracranial carotid stenosis were ≥ 70%, including 5 cases of ulcer disease, one side of the internal carotid artery stenosis with the other side of the internal carotid artery occlusion in 1 case. All patients underwent general anesthesia combined with cervical plexus block anesthesia. Intraoperative placement of all temporary shunt, carotid artery angioplasty in 32 cases. Results There were no deaths in perioperative period in the whole group. The symptoms of cerebral ischemia were significantly improved in 31 cases (77.5%) and in 9 cases (22.5%). One case was complicated by hyperperfusion syndrome and one case was hemodynamically unstable. Perioperative complications of symptomatic carotid stenosis 5.0% (in line with the United States AHA ≤ 6% of the standard). Forty patients were followed up. The bilateral cervical vessels were examined at 6 weeks and 3 months after operation. No vascular restenosis occurred in 1 case. Conclusions CEA is a safe and effective method for the treatment of symptomatic carotid stenosis.