不使用转流管颈动脉内膜剥脱术治疗双侧颈动脉狭窄的安全性分析

摘要

Objective To investigate the safety without shunting during carotid endarterectomy for severe carotid stenosis patients with contralateral carotid normal、light - moderate or severe stenosis. Methods Retrospectively analyze the clinical data of 138 severe carotid steno-sis patients with contralateral carotid light - moderate and severe stenosis,divided to group A(95 cases)and group B(43 cases)based on de-gree of stenosis . To record cardiac complications、new stroke of operation side、death within postoperative 30 days after CEA were performed. Results The success rate of surgical cases was 100% ,CEAs were performed without shunting. Within postoperative 30 days after CEA were performed,2 cases(2. 11% )occurred cardiac complications,3 cases(3. 16% )occurred stroke,1 case(1. 05% )died in the group A,and 2 cases(4. 65% )occurred cardiac complications,1 case(2. 33% )occurred stroke,no death occurred in the group B. There were no significant differences in major adverse events in both groups( P = 1. 000,P = 0. 781,P = 1. 000). The total major adverse events rate was 6. 5% ,stroke and death rate was 3. 6% . Conclusion CEA without shunting is secure for severe carotid stenosis patients with contralateral carotid light - moderate or severe stenosis. With increasing stenosis grade of contralateral carotid will not increase the risk of stroke and death.%目的：探讨颈动脉内膜剥脱术（carotid endarterectomy，CEA）治疗一侧颈动脉重度狭窄伴对侧颈动脉轻-中度及重度狭窄患者不使用转流管的安全性。方法回顾性分析138例一侧颈动脉重度狭窄伴对侧颈动脉不同程度狭窄患者的临床资料，其中对侧颈动脉轻-中度狭窄组95例（A 组），对侧颈动脉重度狭窄组43例（B 组）。随访 CEA 后30 d 内2组患者心脏、术侧新发脑卒中等并发症和病死率。评估对侧颈动脉狭窄的程度对不使用转流管 CEA 的安全性的影响。结果138例患者均成功实施 CEA，术中均未使用转流管。术后30 d 内 A 组出现2例（2.11%）心脏并发症，3例（3.16%）脑卒中，1例（1.05%）死亡。B 组出现2例（4.65%）心脏并发症，1例（2.33%）脑卒中，无死亡病例。2组各不良事件比较差异无统计学意义（P =1.000，P =0.781，P =1.000）。总的主要不良事件发生率为6.5%，卒中及病死率为3.6%。结论不使用转流管 CEA 治疗双侧颈动脉狭窄，安全、有效，随着对侧颈动脉狭窄程度增加并不增加围手术期脑卒中和死亡风险。