颈内动脉假性闭塞手术治疗的单中心经验总结

摘要

目的 评价颈内动脉假性闭塞(atheromatous pseudo-occlusion,APO)手术治疗的安全性及有效性.方法 对复旦大学附属中山医院2011年12月至2016年6月间接受颈动脉内膜切除术的颈动脉狭窄患者资料进行回顾性分析,其中研究组为APO患者32例,对照组为重度狭窄(70％～99％)患者124例.对两组围手术期各主要及次要并发症、随访中的同侧缺血性脑卒中复发率、再狭窄率及死亡率进行比较.结果 围手术期主要并发症:APO组发生心梗1例(3.1％),无缺血性脑卒中、脑出血及死亡病例;对照组发生缺血性脑卒中2例(1.4％),心肌梗死6例(4.2％),死亡1例(0.7％).次要并发症:APO组发生切口渗血1例(3.1％),肺部感染2例(6.3％),高灌注综合征2例(6.3％);对照组发生切口渗血3例(2.1％),切口感染2例(1.4％),肺部感染4例(2.8％),颅神经损伤2例(1.4％),高灌注综合征2例(1.4％).术后随访6～60个月,平均随访(35.3±17.5)个月.APO组1例(3.1％)同侧缺血性脑卒中复发,4例(12.5％)发生再狭窄,死亡3例(9.4％),死因均非神经系统疾病.对照组同侧缺血性脑卒中复发8例(5.6％),再狭窄9例(6.3％),死亡8例(5.6％).两组间围手术期各主要及次要并发症,随访中的同侧缺血性脑卒中复发率、再狭窄率、死亡率的差异均无统计学意义.结论 对APO患者行颈动脉内膜切除术治疗安全有效,围手术期及随访结果满意.%Objective To investigate the efficacy and safety of surgical treatment for internal carotid artery atheromatous pseudo-occlusion (APO).Methods Clinical data of patients with carotid artery stenosis treated by carotid endarterectomy from Dec.,2011 to Jun.,2016 in Zhongshan Hospital Affiliated to Fudan University were analyzed retrospectively.Carotid endarterectomy were performed in 32 patients with pseudo-occlusion of the internal carotid artery (APO group).And 124 patients with traditional severe stenosis (70％-99％) served as control group.Perioperative major and minor complications,recurrence rate of ipsilateral ischemic stroke,restenosisrate and mortality in follow-up were compared between the two groups.Results Perioperative major complications:one patient (3.1 ％) developed myocardial infarction in the APO group,no ischemic stroke,cerebral hemorrhage and death cases;2 (1.4％) ischemic stroke cases,6 (4.2％) myocardial infarction cases and 1 (0.7％)death case was found in control group.Perioperative minor complications:1 (3.1％) incision bleeding case,2 (6.3％) pulmonary infection cases,2 (6.3％) cerebral hyperperfusion syndrome cases were found in APO group;3 (2.1％) incision bleeding cases,2 (1.4％) incision infection cases,4 (2.8％)pulmonary infection cases,2 (1.4％) cranial nerve injury cases,2 (1.4％) cerebral hyperperfusion syndrome cases were found in control group.Patients were followed up for 6-60 months,with mean follow-up period of (35.3 ± 17.5) months.During follow-up,1 (3.1％) ipsilateral ischemic stroke recurrence case,4 (12.5％) restenosis cases,and 3 (9.4％) death cases were found in the APO group.And 8 (5.6％) ipsilateral ischemic stroke recurrence cases,9 (6.3％) restenosis cases,8 (5.6％)death cases were found in control group.There were no significant differences in perioperative major and minor complications,recurrence rate of ipsilateral ischemic stroke,restenosis rate and mortality between the two groups.Conclusions Surgical treatment for atheromatous pseudo-occlusion of the internal carotid artery is safe and effective.Perioperative and follow-up results are satisfactory.