本文選題：頸動(dòng)脈狹窄 + 頸動(dòng)脈內(nèi)膜切除術(shù)�。� 參考：《山東大學(xué)》2014年碩士論文

【摘要】：目的： 1.探討頸動(dòng)脈內(nèi)膜切除術(shù)治療頸動(dòng)脈狹窄的手術(shù)技巧,以提高手術(shù)療效,減少術(shù)中不良事件及術(shù)后并發(fā)癥； 2.術(shù)后長(zhǎng)期隨訪(fǎng)以觀察其臨床療效。 方法： 回顧性分析天津市環(huán)湖醫(yī)院神經(jīng)外科2010年10月-2013年10月53例因頸動(dòng)脈狹窄行頸動(dòng)脈內(nèi)膜切除術(shù)(Carotid Endarterectomy,CEA)患者的臨床資料,其中男性39例,女性14例,男：女之比為2.78：1.00,年齡40～78歲,平均(60.34±8.92)歲；病程2天至4年。臨床表現(xiàn)為短暫性黑蒙(8例)、偏身肢體癱瘓或無(wú)力(34例)、短暫性失語(yǔ)(16例)、頭暈(22例),亦可完全無(wú)癥狀(2例)；同時(shí)伴發(fā)有腔隙性腦梗死或陳舊性腦梗死(37例)、糖尿病(16例)高血壓(43例)和高脂血癥(39例)。狹窄位于右側(cè)頸動(dòng)脈者26例、左側(cè)15例、雙側(cè)12例,其中輕度狹窄(30%)0例、中度狹窄(30%～69%)35例、重度狹窄(70%-99%)16例、完全閉塞(100%)2例,雙側(cè)狹窄者根據(jù)臨床癥狀決定手術(shù)側(cè)別,完全閉塞者依據(jù)數(shù)字剪影血管造影(digital subtraction angiography,DSA)判定遠(yuǎn)端血流是否通暢,通暢者給予手術(shù),手術(shù)類(lèi)別可分為單純頸動(dòng)脈內(nèi)膜切除術(shù)(50例)、頸動(dòng)脈內(nèi)膜切除術(shù)聯(lián)合動(dòng)脈瘤夾閉術(shù)(2例)、頸動(dòng)脈支架植入術(shù)(carotid artery stenting,CAS)后因管腔狹窄行頸動(dòng)脈內(nèi)膜切除術(shù)并支架取出術(shù)(1例)。本組病例均行單側(cè)手術(shù),2例完全閉塞者DSA示左側(cè)頸內(nèi)動(dòng)脈遠(yuǎn)端血流通暢,均行左側(cè)CEA。 術(shù)后3至24月內(nèi)進(jìn)行電話(huà)隨訪(fǎng),根據(jù)該組患者術(shù)前及術(shù)后癥狀改善的資料,進(jìn)行定量資料的配對(duì)設(shè)計(jì),并應(yīng)用SAS數(shù)據(jù)分析軟件進(jìn)行分析。 結(jié)果： 1.術(shù)后1例因突發(fā)心肌梗死死亡；2例出現(xiàn)手術(shù)側(cè)頸部皮膚麻木；1例出現(xiàn)聲音嘶啞,考慮全身麻醉氣管插管損傷所致,經(jīng)布地奈德霧化吸入治療癥狀消失；3例術(shù)后仍有輕度短暫性腦缺血發(fā)作(transient ischemic attack,TIA),但無(wú)腦卒中或腦梗死病例,術(shù)后頸部CT血管造影(computed tomography angiography,CTA)和核磁灌注功能成像(functional magnetic resonance imaging,fMRI)檢查提示頸動(dòng)脈形態(tài)良好、血流通暢；腦血流灌注有不同程度改善。 2.所有患者隨訪(fǎng)3-24個(gè)月,術(shù)前癥狀均有不同程度改善,TIA癥狀消失。其中,2例患者出現(xiàn)手術(shù)側(cè)頸部皮膚麻木感,術(shù)后3個(gè)月癥狀消失；9例仍有反應(yīng)遲鈍、記憶力減退、動(dòng)作遲緩等慢性腦缺血癥狀,但程度較術(shù)前有明顯的改善；3例術(shù)后短期內(nèi)表現(xiàn)為T(mén)IA,術(shù)后2個(gè)月消失。 結(jié)論： 1.統(tǒng)計(jì)結(jié)論：t=-13.740,P0.0001,按α=0.05水準(zhǔn),認(rèn)為差異有統(tǒng)計(jì)數(shù)意義,CEA術(shù)后患者癥狀明顯改善； 2.頸動(dòng)脈內(nèi)膜切除術(shù)是治療頸動(dòng)脈狹窄安全、有效的外科治療方法； 3.正確合理的選擇手術(shù)適應(yīng)癥、醫(yī)師嫻熟的手術(shù)技術(shù)及技巧的應(yīng)用是保證手術(shù)成功、提高療效的關(guān)鍵； 4.頸動(dòng)脈內(nèi)膜切除術(shù)是頸動(dòng)脈支架置入術(shù)后再狹窄的補(bǔ)救治療措施。
[Abstract]:Objective:1.To explore the surgical techniques of carotid endarterectomy in the treatment of carotid artery stenosis in order to improve the curative effect and reduce the adverse events and postoperative complications.2.Postoperative long-term follow-up to observe its clinical efficacy.Methods:The clinical data of 53 patients undergoing carotid endarterectomy (Carotid Endarterectomy1) due to carotid artery stenosis from October 2010 to October 2013 in Tianjin Huanghu Hospital were retrospectively analyzed. There were 39 males and 14 females, the ratio of male to female was 2.78: 1.00, aged 400-78 years.The mean age was 60.34 鹵8.92 years, the course of disease was 2 days to 4 years.The clinical manifestations were transient black mongolicus in 8 cases, hemiplegia or weakness in 34 cases, transient aphasia in 16 cases, dizziness in 22 cases, complete asymptomatic syndrome in 2 cases, accompanied by lacunar cerebral infarction or old cerebral infarction in 37 cases, glucose in 37 cases.Hypertension (43 cases) and hyperlipidemia (39 cases).There were 26 cases of stenosis in the right carotid artery, 15 cases on the left side and 12 cases on the bilateral side. Among them, 30 cases were mild stenosis, 306935 cases were moderate stenosis, 16 cases were severe stenosis, 16 cases were located in the right carotid artery, and 2 cases were completely occluded. The patients with bilateral stenosis decided the operation side according to the clinical symptoms.The patients with complete occlusion were judged by digital subtraction angiography to determine whether the distal blood flow was patency and the patency was performed.The types of operation could be divided into 50 cases of carotid endarterectomy, 2 cases of carotid endarterectomy combined with aneurysm clipping, and 1 case of carotid endarterectomy and stent removal after carotid artery stenting after carotid artery stenting.All the patients underwent unilateral operation and 2 patients with complete occlusion underwent DSA showing patency of the distal end of the left internal carotid artery.The patients were followed up by telephone from 3 to 24 months after operation. According to the data of symptom improvement before and after operation, the pairing design of quantitative data was carried out and analyzed by SAS data analysis software.Results:1.Postoperative death due to sudden myocardial infarction occurred in 2 patients with postoperative neck skin numbness and hoarseness in 1 case, which was caused by tracheal intubation injury under general anesthesia.The symptoms disappeared after budesonide atomization inhalation in 3 patients with mild transient ischemic attack-TIAA, but there was no stroke or cerebral infarction.Ct tomography angiography and nuclear magnetic perfusion functional magnetic resonance imagingfMRI showed that the carotid artery was in good shape and the blood flow was patency, and cerebral blood perfusion was improved to some extent.2.All patients were followed up for 3-24 months.Among them, 2 cases had skin numbness on the side of the neck, 9 cases had chronic cerebral ischemia symptoms, such as slow reaction, memory loss, slow movement and so on, the symptoms disappeared 3 months after operation, and 9 cases were still suffering from chronic cerebral ischemia.However, the degree of TIA was significantly improved in 3 cases after operation and disappeared 2 months after operation.Conclusion:1.Conclusion the statistical results showed that the difference was statistically significant in the improvement of postoperative symptoms of CEA patients according to the level of 偽 -0.05.2.Carotid endarterectomy is a safe and effective surgical treatment for carotid stenosis.3.The correct and reasonable choice of surgical indications and the application of skilled surgical techniques and techniques are the key to ensure the success of the operation and to improve the curative effect.4.Carotid endarterectomy is a remedy for restenosis after carotid stenting.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R653

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 程振國(guó);孫來(lái)廣;高俊紅;王進(jìn)中;陳鳳國(guó);;頸動(dòng)脈內(nèi)膜剝脫術(shù)治療頸動(dòng)脈狹窄[J];河南外科學(xué)雜志;2009年01期

2 唐小斌;陳忠;李慶;鄧?guó)櫲?吳章敏;寇鐳;劉暉;羅小云;韓延民;何楠;吳慶華;;頸動(dòng)脈內(nèi)膜剝脫術(shù)相關(guān)臨床問(wèn)題的探討[J];心肺血管病雜志;2009年03期

3 張小明,張學(xué)民,李偉,沈晨陽(yáng),焦洋,蔣京軍,袁鏈,李清樂(lè);頸動(dòng)脈硬化內(nèi)膜剝脫術(shù)預(yù)防腦梗死94例分析[J];中國(guó)實(shí)用外科雜志;2005年08期

4 符偉國(guó);王利新;王玉琦;;顱外段頸動(dòng)脈狹窄治療指南[J];中國(guó)實(shí)用外科雜志;2008年11期

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