专题研究(Monographic Study)

症状性颈内动脉闭塞的术前评估及手术治疗

Published at: 2016年第25卷第12期

戚悠飞 1,2 , 肖占祥 1 , 曾昭凡 1 , 岳劼 1 , 陈浩 1 , 刘飒华 1 , 张文波 1 , 舒畅 2
1 海南省人民医院 血管外科,海南 海口 570311
2 中南大学湘雅二医院 血管外科,湖南 长沙410011
通讯作者 占祥 肖 Email: xiaozhanxianghn@sina.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2016.12.007
基金:
海南省自然科学基金资助项目 813205
海南省社会发展科技专项基金资助项目 2015SF04

摘要

目的:探讨症状性颈内动脉(ICA)闭塞患者手术治疗的效果和术前评价方法。方法:选择海南省人民医院血管外科2010年1月—2016年3月手术治疗的11例ICA闭塞的患者,2例行颈动脉内膜剥脱术(CEA),9例行CEA加取栓术。术前均行头颈联合CTA和颈部血管彩超,部分患者行脑CT灌注成像、经颅彩色多普勒超声以及脑血管造影等检查,观察患者围术期与长期疗效。结果:所有患者ICA闭塞均为单侧,其中4例对侧ICA有<50%的狭窄。闭塞主要位于ICA起始端,8例闭塞段延至颅底,闭塞长度16~85 mm。术前颈动脉彩超均在可在颅底探及ICA血流。10例手术再通成功,1例失败。术后10例脑缺血症状明显改善,其中3例出现过度灌注综合征。随访期,1例患者ICA在术后3个月闭塞。1例在术后18个月死亡。结论:手术治疗ICA闭塞具有满意安全的围手术期效果和较好的中远期效果。术前精确的评估是手术成功的关键。


Preoperative assessments and surgical treatment of symptomatic internal carotid arteries occlusion

Abstract

Objective: To investigate the effect of surgical treatment and preoperative assessment methods for symptomatic internal carotid artery (ICA) occlusion. Methods: The clinical data of 11 patients with symptomatic ICA occlusion undergoing surgical treatment from January 2010 to March 2016 in Department of Vascular Surgery of Hainan General Hospital were analyzed retrospectively. Of the patients, 2 cases underwent carotid endarterectomy (CEA) and 9 cases underwent CEA plus embolectomy. Before operation, all patients underwent intracranial and cervical CTA and carotid duplex ultrasonography, and some patients underwent head CT perfusion, transcranial Doppler and whole-brain angiography. The perioperative and long-term results of the patients were observed. Results: All patients had unilateral ICA occlusion, and 4 cases of them had a less than 50% diameter stenosis in the contralateral ICA. Occlusion was mainly located in the initial segment of ICA, and occlusive lesion extended to the skull base in 8 cases, and the length of occlusion ranged from 16 to 85 mm. The blood flow of ICA was detected in the skull base by color Doppler ultrasound in all patients before operation. Recanalization was successfully achieved in 10 patients and failed in 1 case. After operation, the symptoms of cerebral ischemia were significantly relieved in the 10 patients, of whom 3 cases developed hyperperfusion syndrome. During the follow-up period, ICA occlusion occurred in 1 patient at 3 months after operation, and 1 patient died 18 months after operation. Conclusion: For ICA occlusion, surgical treatment offers satisfactory and safe perioperative efficacy as well as good mid- and long-term results. Accurate preoperative assessment is essential for surgical success.


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引用

引用本文: 悠飞 戚, 占祥 肖, 昭凡 曾, 劼 岳, 浩 陈, 飒华 刘, 文波 张, 畅 舒. 症状性颈内动脉闭塞的术前评估及手术治疗[J]. 中国普通外科杂志, 2016, 25(12): 1707-1712.
Cite this article as: QI Youfei, XIAO Zhanxiang, ZENG Zhaofan, YUE Jie, CHEN Hao, LIU Sahua, ZHANG Wenbo, SHU Chang . Preoperative assessments and surgical treatment of symptomatic internal carotid arteries occlusion [J]. Chin J Gen Surg, 2016, 25(12): 1707-1712.