本文選題：頸動脈內(nèi)膜剝脫術 + 頸動脈支架植入術　； 參考：《吉林大學》2017年碩士論文

【摘要】：目的:腦卒中,即使是TIA,嚴重影響著患者的生活質(zhì)量,又是致殘的主要病因,世界衛(wèi)生組織2012年公布的死亡原因中腦卒中在中高收入國家占首位[1],美國每年約有70萬人發(fā)生腦卒[2]。因此,對頸動脈狹窄性疾病的治療顯得尤為重要。自1953年Michael De Bakey完成第一例CEA,至今,CEA已逐漸成為頸動脈狹窄性疾病治療的金標準。但是近年來介入技術快速發(fā)展及操作者技術不斷提高,CAS越來越多地被應用于缺血性腦卒中的治療。二者孰優(yōu)孰劣,越來越被現(xiàn)代學者及臨床工作者關注,成為研究熱點。本文回顧性分析我科自2010-2013年頸動脈狹窄患者的臨床資料,篩查出經(jīng)CEA或CAS治療的患者,在術后再狹窄、圍手術期重大心腦血管不良事件及術后切口并發(fā)癥等方面的發(fā)生率對二者進行比較。方法:共納入自2010-2013年182名在我科治療的頸動脈狹窄患者,分為2組,108名患者行CEA治療,74名患者行CAS治療,男性121名,女性61名,年齡52-79歲之間。通過門診隨訪追蹤患者情況,要求患者分別于術后3個月、12個月、24個月回院檢查,其中隨訪時間最短的是3個月,最長的為24個月,平均隨訪18.71±4.51個月。通過CTA或者多普勒彩色超聲觀察頸動脈血管的通常情況,如狹窄50%則定義為頸動脈再狹窄。隨訪內(nèi)容主要為術后3個月及術后2年內(nèi)再狹窄率、術后切口并發(fā)癥發(fā)生率、及圍手術期MACCE發(fā)生率。通過SPSS19.0軟件進行卡方檢驗和t檢驗,當P0.05時有顯著差異。比較兩組患者術后切口并發(fā)癥、再狹窄,及圍手術期重大心腦血管不良事件等的發(fā)生率情況。結(jié)果:兩組術后切口并發(fā)癥并無顯著差異;3個月內(nèi)CEA組有2人發(fā)生再狹窄,CAS組有3人,無顯著統(tǒng)計學差異(P值=0.67),CEA組其中1人術后24小時內(nèi)多次出現(xiàn)一過性頭痛、眩暈,觸及頸動脈搏動不清,考慮急性血栓形成,立返手術室切開取栓,術后癥狀逐漸好轉(zhuǎn),另外1人術后3個月復查頸部動脈CTA時發(fā)現(xiàn)狹窄率約50%,但無明顯臨床癥狀,未予以特殊處理;CAS組3人復查頸動脈CTA時發(fā)現(xiàn)狹窄50%,伴頭暈、一過性黑蒙等癥狀,其中2人行球囊擴張術后癥狀消失,1人再狹窄段位于頸總動脈分叉近心端,行自體大隱靜脈轉(zhuǎn)流術,術后癥狀消失。2年時CEA組有4人發(fā)生再狹窄,CAS組4人發(fā)生再狹窄,無顯著統(tǒng)計學差異(P值=0.86),CEA組1人行二次頸動脈內(nèi)膜剝脫術,術后癥狀消失,CAS組1人行二次頸動脈支架植入術,術后癥狀消失,其余患者均行保守治療后癥狀好轉(zhuǎn);術后30天及2年TLR發(fā)生率無顯著差異,且二次術后無再狹窄情況;CAS組較CEA組有較高的腦卒中發(fā)生率,為9.46%,尤其對于70歲以上患者發(fā)病率更高,為50%,這里腦卒中的發(fā)生率包括重大腦卒中及TIA,兩組腦卒中發(fā)生率的差異主要來自小卒中的發(fā)生,重大腦卒中的發(fā)生率并無顯著差異;兩種手術方式在死亡率上取得較為滿意的結(jié)果,總體死亡率較低,為1.65%;圍手術期MACCE發(fā)生率,CEA組為3.70%,CAS組為5.41%,兩組數(shù)據(jù)無明顯統(tǒng)計學差異。結(jié)論:CEA組與CAS組在術后切口并發(fā)癥、再狹窄、TLR及圍手術期重大腦卒中/死亡/心梗等不良事件的發(fā)生率上均無顯著差異,問世僅約16年的CAS,發(fā)展前景令人期待!而CEA,更適用于高齡患者。所以,二者對頸動脈狹窄疾病的治療效果是相當?shù)挠质窍噍o相承的!
[Abstract]:Objective: stroke, even TIA, seriously affects the quality of life of the patients, and is the main cause of disability. In 2012, the WHO published the cause of death in the middle and high income countries which accounted for the first [1]. In the United States, about 700 thousand people have cerebral pawns every year, so the treatment of carotid stenosis is particularly important. Since 1953, the treatment of carotid artery stenosis is particularly important. Michael De Bakey completed the first case of CEA, so far, CEA has gradually become the gold standard for the treatment of carotid stenosis. However, in recent years, the rapid development of the interventional technique and the continuous improvement of operator technology, and more and more applications of CAS to the treatment of ischemic stroke. The two are better and worse, and are becoming more and more closely related to modern scholars and clinical workers. A retrospective analysis of the clinical data of patients with carotid stenosis in 2010-2013 years was reviewed. The incidence of postoperative restenosis, major peri operative cardiovascular adverse events and postoperative incision complications was compared between the two patients who had been treated with CEA or CAS. Methods: a total of 2010-2013 years 1 years were included. 82 patients with carotid stenosis treated in our department were divided into 2 groups, 108 patients were treated with CEA, 74 patients were treated with CAS, 121 men, 61 women and 52-79 years old. The patients were followed up for 3 months, 12 months and 24 months after 2 months, and the shortest follow-up time was the shortest, the longest was 3 months, the longest The average follow-up of 24 months was 18.71 + 4.51 months. The common carotid artery blood vessels were observed by CTA or Doppler color ultrasound. 50% of the stenosis were defined as carotid restenosis. The follow-up was mainly followed by 3 months after operation and 2 years after operation, the incidence of postoperative incision complications, and the incidence of MACCE in the perioperative period. Through SPSS19.0 The software carried out the chi square test and t test, and there were significant differences when P0.05. Compared the incidence of postoperative incision complications, restenosis, and perioperative major cardio cerebral vascular adverse events in the two groups. Results: there was no significant difference in postoperative incision complications between the two groups; in group CEA, there were 2 restenosis in group CEA, and there were 3 in group CAS, and no significant unification. The study difference (P value =0.67), in group CEA, 1 of them had a recurrent headache, dizziness, not clear carotid artery pulsation within 24 hours after operation, and the formation of acute thrombus was taken into consideration in the operation room. The symptoms gradually improved after the operation in the operation room. The other 1 people found that the stenosis rate was about 50%, but there was no obvious clinical symptom, but no obvious clinical symptoms were found in the other 1 patients after 3 months of operation. With special treatment, 3 people in group CAS reexamined the carotid artery CTA and found the symptoms of stenosis 50%, dizziness, and primary dark Mongolian, of which 2 of them disappeared after balloon dilatation, 1 restenosis was located in the proximal central end of the common carotid artery, and the autologous great saphenous vein reflow was performed. The restenosis occurred in the group of CEA after.2 years, and 4 in the CAS group occurred again. There was no significant difference in statistical difference (P value =0.86), 1 people in group CEA were treated with two times carotid endarterectomy, the symptoms disappeared, 1 patients in group CAS were treated with two carotid artery stenting, the symptoms disappeared, and the rest of the patients improved after conservative treatment; there was no significant difference in the incidence of TLR in 30 and 2 years after the operation, and there was no restenosis after two operations; CAS There was a higher incidence of stroke in the group than the CEA group, 9.46%, especially for patients over 70 years of age, with a higher incidence of 50%. The incidence of stroke included major stroke and TIA. The difference in the incidence of stroke in the two groups was mainly from the occurrence of the stroke, and there was no significant difference in the incidence of major stroke; the two surgical methods were in the mortality rate. The overall mortality rate was low, 1.65%, the incidence of MACCE in the perioperative period, the group CEA was 3.70%, the group CAS was 5.41%, and the two groups had no significant statistical difference. Conclusion: the incidence of postoperative complications, restenosis, TLR and major stroke / death / myocardial infarction in the CEA group and the CAS group were not obvious. The difference is that the CAS is only about 16 years old, and the prospect of development is expected! And CEA is more suitable for the elderly patients. Therefore, the treatment effect of the two on the stenosis of the carotid artery is equal and complementary to each other.

【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3

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