【摘要】：頸動脈內膜切除術(CEA)是治療頸動脈狹窄、預防腦卒中的"金標準",國外已相對成熟,國內雖起步晚,但發(fā)展迅速。筆者在CEA的推廣過程中,發(fā)現(xiàn)很多同道雖然可基本掌握手術技巧,但在概念理解、術式選擇、技術理念、并發(fā)癥防治等方面與國際先進水平仍存差距。很多同道在實際工作中仍在糾結于以下問題:CEA是切斑塊還是切內膜?如何切除?切除的部位?切除到何種程度?是否需加做血管裁剪和吻合口成形?本文針對CEA在"真實世界"中的四則爭議——概念存疑、術式糾結、理念差異和技術困惑——進行概括并提出個人思考,同時與各位讀者分享本領域的最新進展。
[Abstract]:Carotid endarterectomy (CEA) is a "golden standard" for the treatment of carotid stenosis and the prevention of stroke. It has been relatively mature abroad. Although it started late at home, it has developed rapidly. In the process of popularizing CEA, it is found that although many of them can master basic surgical techniques, there is still a gap between them in terms of understanding of concepts, choice of surgical procedures, technical concepts, prevention and treatment of complications and so on. Many colleagues are still struggling with the following questions in practical work: is CEA cutting plaques or endomembranes? How? The excised part? To what extent? Is there a need for vascular clipping and anastomosis? In this paper, four controversies of CEA in the "real world"-doubt of concept, entanglement of operation, difference of concept and technical confusion-are summarized and personal thinking is put forward. At the same time, the latest progress in this field is shared with readers.
【作者單位】： 第二軍醫(yī)大學長征醫(yī)院血管外科;
【基金】：上海高校特聘教授(東方學者)跟蹤計劃基金(GZ2016008) 上海領軍人才基金(035) 國家自然科學基金(81570440) 上海市科委2016年度醫(yī)學引導類(中、西醫(yī))科技支撐項目基金(16411966500)~~
【分類號】：R651.12

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