摘要
目的探讨采用颈动脉内膜切除术(CEA)治疗症状性颈动脉狭窄患者的临床疗效及其手术时机。方法回顾性分析2012年9月至2018年5月苏州大学附属第一医院神经外科采用CEA治疗的146例症状性颈动脉狭窄患者的临床资料。根据患者首次出现症状至行CEA的时间,将患者分为A组(≤14 d,57例)和B组(>14 d,89例)。术后5 d,对所有患者行CT灌注成像(CTP)和经颅多普勒(TCD)检查,且对卒中患者行美国国立卫生研究院卒中量表(NIHSS)评分。出院后12个月行门诊随访,包括复查CTP和TCD、对卒中患者行NIHSS评分及观察是否出现手术侧再狭窄。结果146例患者中,1例(0.7%)在围手术期发生卒中。与术前比较,146例患者术后5 d基底核和颞叶的脑血流量和脑血容量均升高(均P<0.05),而平均通过时间(MTT)和达峰时间(TTP)均缩短(均P<0.05);大脑中动脉平均流速(MVMCA)和搏动指数(PI)值均增加(均P<0.001)。88例卒中患者的NIHSS评分较术前降低[中位数(上、下四分位数)分别为1.0(0,2.0)分、3.0(2.0,5.8)分,P<0.001]。术后12个月随访,以上指标与术后5 d比较差异均无统计学意义(均P>0.05);其中6例患者(4.1%,6/146)发生手术侧再狭窄。两组患者的年龄、性别、病史、吸烟史、发作症状及颈动脉狭窄程度的差异均无统计学意义(均P>0.05)。术后5 d、12个月,A组的MVMCA变化率均高于B组[中位数(上、下四分位数):术后5 d分别为41.0(16.7,78.1)%、18.9(4.9,44.3)%,术后12个月分别为40.5(13.0,76.6)%、15.9(7.2,38.1)%,均P<0.05];A组卒中患者的NIHSS评分变化率均高于B组[中位数(上、下四分位数):术后5 d分别为-100.0(-100.0,-60.0)%、-66.7(-100.0,-50.0)%,术后12个月分别为-100.0(-100.0,-58.6)%、-50.0(-100.0,-33.3)%,均P<0.05]。结论CEA可明显改善症状性颈动脉狭窄患者的脑灌注、脑血流动力学及部分神经功能,同时早期手术效果更佳。
Objective To explore the clinical outcomes of carotid endarterectomy(CEA)on patients with symptomatic carotid stenosis and its correlation with the timing of surgery.Methods A retrospective analysis was conducted on the clinical data of 146 patients with symptomatic carotid stenosis treated with CEA at Neurosurgery Department of the First Affiliated Hospital of Soochow University from September 2012 to May 2018.All 146 patients were divided into group A(≤14 d,57 cases)and group B(>14 d,89 cases)according to the time from the initial symptoms to CEA.All patients underwent CT computed tomography perfusion(CTP)and transcranial doppler(TCD),and stroke patients were evaluated by the National Institutes of Health stroke scale(NIHSS)at 5 days after surgery.All patients were followed up on an outpatient basis 12 months after discharge,including re-examination of CTP and TCD,NIHSS scores for stroke patients,and observation of surgical-side restenosis.Results Perioperative stroke occurred in 1(0.7%)of the 146 patients.Compared with preoperative 5 days after surgery,cerebral blood flow and cerebral blood volume were increased,and mean transit time(MTT)and time to peak(TTP)were shortened in the basal ganglia and temporal lobe of 146 patients(all P<0.05).The mean flow velocity of MCA and pulsatility index(PI)value were increased(both P<0.001).Eighty-eight patients with stroke had lower NIHSS scores than before surgery[1.0(0,2.0)points vs.3.0(2.0,5.8)points,P<0.001].Up to the last follow-up,there was no significant difference between the above indicators and 5 days after surgery(all P>0.05).Six patients(4.1%,6/146)had restenosis on the surgical side.There were no significant differences in age,gender,medical history,smoking history,onset symptoms,or degree of carotid stenosis between the two groups of patients(all P>0.05).The change rate of MVMCA in group A was higher than that in group B at 5 days and 12 months after operation[5 days after operation:41.0(16.7,78.1)%,18.9(4.9,44.3)%,12 months after operation:40.5(13.0,76.6)%
作者
潘香君
惠品晶
丁亚芳
颜燕红
张白
王润川
张翌
黄亚波
胡春洪
方琪
Pan Xiangjun;Hui Pinjing;Ding Yafang;Yan Yanhong;Zhang Bai;Wang Runchuan;Zhang Yi;Huang Yabo;Hu Chunhong;Fang Qi(Department of Cerebrovascular Ultrasound,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Neurosugery,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Radiology,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Neurology,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2020年第1期32-37,共6页
Chinese Journal of Neurosurgery
基金
苏州市民生科技示范工程项目(SS201714,SS201859)
江苏省干部保健科研项目(BJ17010)
江苏省科技厅社会发展项目-重点病种规范化诊疗项目(BE2016670)
江苏省医学创新团队(领军人才)(CXTDA2017026)
科技部十三五重大专项(2017YFC0114302)。
