颈动脉极度狭窄的诊断和手术

摘要

目的 探讨颈动脉极度狭窄的诊断和手术处理特点.方法 2000年1月至2009年12月手术治疗颈动脉极度狭窄患者53例,53例术侧颈动脉狭窄均超过95%,其中28例伴对侧颈动脉狭窄或闭塞.回顾性分析53例患者的临床和影像学资料及手术效果.结果 45例术后无任何并发症.3例术后早期血压、心率或心律不稳定,1例心肌缺血,1～2 d内恢复正常;1例轻度声音嘶哑与饮水呛咳;1例因深静脉置管引起菌血症;2例并发脑出血.全组未发生围手术期脑缺血.结论 对颈动脉极度狭窄患者应尽早施行颈动脉内膜切除,围手术期的脑缺血风险很低,很少需作术中转流,但需警惕高灌注综合征和脑出血;采用显微外科技术可降低再狭窄的发生率.%Objective To explore the speciality of diagnosis and surgery of tight carotid stenosis.Method From January 2000 to December 2009,53 patients with tight carotid stenosis ( ＞ 95% ) were operated on. All 53 patients had tight carotid stenosis more than 95% on one side in whom 28 had contralateral carotid stenosis or occlusion. The clinical and imaging data as well as surgical outcomes of the patients were retrospectively analyzed. Results Forty-five patients bad postoperatively done well without any complications. There were 3 cases of hemodynamic instability and one case of cardiac ischemia which resolved in one to two days. One patient developed mild hoarseness. One complicated with bacteremia due to deep vein catheter insertion. Two patients experienced brain hemorrhage. None of this series occurred perioperative brain ischemia Conclusions Tight carotid stenosis indicates a need for expeditious carotid endarterectomy with very low rates of brain ischemia Intraoperative shunting is seldom necessary.Postoperative hyperperfusion syndrome and brain hemorrhage should be warried. Microendarterectomy can effectively prevent from restenosis.