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中华脑科疾病与康复杂志(电子版)

中华脑科疾病与康复杂志(电子版) ›› 2020, Vol. 10 ›› Issue (03) : 160 -164. doi: 10.3877/cma.j.issn.2095-123X.2020.03.007

所属专题： 文献；

临床研究

颈动脉转流管在颈动脉内膜切除术中的临床应用
周帅1, 高秀琴1, 姜丽娜1, 王明鑫1,†(), 韩光良1, 李超1, 王鲁飞1, 郭嘉1, 刘炜1   
  1. 1. 257000　山东东营，胜利油田中心医院神经外科&头颈血管外科
  • 收稿日期:2020-09-08 出版日期:2020-06-15
  • 通信作者: 王明鑫

Clinical application of carotid shunt in carotid endarterectomy

Shuai Zhou1, Xiuqin Gao1, Lina Jiang1, Mingxin Wang1,†(), Guangliang Han1, Chao Li1, Lufei Wang1, Jia Guo1, Wei Liu1   

  1. 1. Department of Neurosurgery & Head and Neck Vascular Surgery, Shengli Oilfield Central Hospital, Dongying 257000, China
  • Received:2020-09-08 Published:2020-06-15
  • Corresponding author: Mingxin Wang
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引用本文：

周帅, 高秀琴, 姜丽娜, 王明鑫, 韩光良, 李超, 王鲁飞, 郭嘉, 刘炜. 颈动脉转流管在颈动脉内膜切除术中的临床应用[J]. 中华脑科疾病与康复杂志(电子版), 2020, 10(03): 160-164.

Shuai Zhou, Xiuqin Gao, Lina Jiang, Mingxin Wang, Guangliang Han, Chao Li, Lufei Wang, Jia Guo, Wei Liu. Clinical application of carotid shunt in carotid endarterectomy[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2020, 10(03): 160-164.

目的

探讨颈动脉转流管在颈动脉内膜切除术（CEA）中的应用价值。

方法

收集胜利油田中心医院神经外科&头颈血管外科2013年1月至2019年8月935例行CEA患者的临床资料，纳入统计标本的有304例症状性颈动脉重度狭窄合并颅内血流代偿较差的患者。术中行转流管转流的患者为转流管组（98例），术中未行转流管转流的患者为对照组（206例），通过比较2组患者术后症状改善率、术后并发症发生率及血管再狭窄发生率，对术中转流管的应用进行全面系统的研究。

结果

转流管组和对照组的术中颈动脉阻断时间分别为（2.3±0.6）min和（13.6±8.2）min，术后出现颅脑过度灌注发生率分别为1.02%（1/98）和7.28%（15/206），2组对比差异均有统计学意义（P<0.05）；2组患者术后症状改善率、术后其他并发症发生率及血管再狭窄发生率比较差异无统计学意义（P>0.05）。

结论

对于症状性颈动脉重度狭窄合并颅内血管代偿较差的患者，CEA中转流管的熟练应用是安全可靠的。

关键词: 颈动脉狭窄, 颈动脉内膜切除术, 转流管
Objective

To explore the application value of carotid shunt in carotid endarterectomy (CEA).

Methods

Collect clinical data of 935 CEA patients in Shengli Oilfield Central Hospital from January 2013 to August 2019, there were 304 patients with severe symptomatic carotid stenosis with poor compensation for intracranial blood flow. Among them, the patients who underwent transflow were the transflow group (98 cases), the patients who did not perform the transflow during the operation were the control group (206 cases). By comparing the rates of symptom improvement, postoperative complications and vascular restenosis in the two groups, the application of intraoperative transfer tube is studied systematically.

Results

The time of carotid artery occlusion was (2.3±0.6) min and (13.6±8.2) min in the transflow group and the control group, respectively. The incidence of postoperative cerebral hyperperfusion was 1.02% (1/98) and 7.28% (15/206), respectively. The differences between the two groups were statistically significant (P<0.05). However, there was no significant difference in the improvement rate of postoperative symptoms, the incidence of other postoperative complications and the incidence of vascular restenosis between the two groups (P>0.05).

Conclusion

For the patients with symptomatic severe carotid stenosis and poor intracranial vascular compensation, the skilled application of CEA shunt tube is a safe and reliable technology and worthy of promotion.

Key words: Carotid artery stenosis, Carotid endarterectomy, Carotid shunt
表1 2组患者临床资料比较
项目 转流管组（n=98） 对照组（n=26） t/χ2值 P值
性别     0.004 0.950
  男 51 108    
  女 47 98    
年龄（岁） 72.6±9.3 69.8±10.5 2.252 0.250
高血压     0.112 0.737
  是 91 189    
  否 7 17    
糖尿病     0.665 0.415
  是 52 99    
  否 46 107    
心脏疾病     0.781 0.377
  是 32 78    
  否 66 128    
吸烟     0.625 0.429
  是 40 94    
  否 58 112    
术前脑卒中症状     2.449 0.294
  脑梗死 26 67    
  短暂性脑缺血发作 24 36    
  肢体麻木无力 48 103    
图1 颈动脉转流管在颈动脉内膜切除术中应用的影像学资料
表2 2组患者术后脑卒中症状出现情况
症状 转流管组（n=98） 对照组（n=206） χ2值 P值
短暂性脑缺血发作     0.097 0.755
  是 1 3    
  否 97 203    
急性血栓     0.958 0.328
  是 0 2    
  否 98 204    
致残性脑梗死     0.477 0.490
  是 0 1    
  否 98 205    
表3 2组患者术后血管再狭窄情况
组别 例数 血管再狭窄 χ 2值 P值
是 否
术后3个月       0.477 0.490
  转流管组 98 0 98    
  对照组 206 1 205    
术后1年       0.961 0.327
  转流管组 95 0 95    
  对照组 199 2 197    
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