摘要
目的 探讨颈动脉内膜切除术（CEA）治疗颈动脉狭窄的安全性和近远期疗效.方法 回顾性分析2006年1月至2014年9月北京协和医院血管外科收治的572例颈动脉狭窄患者,共实施618例次CEA手术.其中男470例,女102例,年龄36 - 87岁,平均年龄66岁.症状性颈动脉狭窄占58.2％,高危患者占26.9％,对侧颈动脉重度狭窄或闭塞占35.6％.结果 所有手术均获得成功,围手术期主要并发症（死亡、脑卒中、心肌梗死）发生率为3.7％,症状性颈动脉狭窄、高危患者及对侧颈动脉严重病变并不增加围手术期主要并发症发生风险.随访511例,平均随访时间42个月（0.5 -86个月）,随访期主要并发症发生率为8.5％,再狭窄率为3.3％.生存分析结果显示,症状性颈动脉狭窄及高危人群不增加术后远期主要并发症发生风险,但对侧颈动脉严重病变增加远期死亡/脑卒中的发生风险.结论 CEA足治疗颅外段颈动脉狭窄的安全有效方法.术前对患者进行充分评估、制定合理的手术方案、精细化手术操作和围手术期管理是提高CEA安全性、降低手术并发症的关键.
Objective To evaluate the safety and early and late outcomes of carotid endarterectomy in treating extracranial carotid artery stenosis.Methods From January 2010 to September 2014,572 consecutive patients with carotid artery stenosis underwent 618 CEA operations.470 patients were males and 102 patients were females.Their age range was 36-87 years old.Average age was 66 years old.Among these patients,symptomatic carotid artery stenosis is 58.2%,CEA high-risk patient is 26.9% and 35.6% patients combined contralateral carotid artery heavy stenosis or totally occlusion.Results All the operations were success.Overall,perioperative major adverse events （death/stroke/MI,MAEs） rates were 3.7%.The risk of MAEs was not associated with whether symptomatic carotid artery stenosis,CEA high-risk patients and the lesions of contralateral carotid artery or not.511 patients were followed up for a mean period of 42 months.MAEs rate in follow-up period is 8.5% and restenosis rate is 3.3%.The results of KaplanMeier survival analysis show symptomatic carotid artery stenosis and CEA high-risk patients couldn＇t increase the risk of MAEs.However,heavy stenosis in contralateral carotid artery could increase the rate of death and stroke in the late follow-ups.Conclusions CEA is a safety and effective method to treat extracranial carotid artery stenosis.The keys to prevent perioperative complications include a comprehensive evaluation of the patients＇ condition,an optional and pcrsonal surgical plan prior to the operations,and a dedicated management during the operations.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2015年第24期1897-1901,共5页
National Medical Journal of China
