摘要
目的比较颈动脉内膜剥脱术(carotid endarterectomy,CEA)和颈动脉支架植入术(carotid artery stenting,CAS)治疗颈动脉狭窄患者的围手术期及中远期预后差异。方法回顾性分析2011年1月至2020年8月期间于北京安贞医院血管外科行手术治疗的1329例颈动脉狭窄患者的临床及随访资料,根据治疗方式不同分为CAS组和CEA组,比较两组的治疗效果。结果两组年龄(t=0.098,P=0.023)、饮酒情况(χ^(2)=8.055,P=0.005)差异均有统计学意义,CEA组合并不稳定斑块较多(χ^(2)=4.392,P=0.038),CAS组合并较多双侧病变(χ^(2)=9.673,P=0.038)。围手术期,CEA组应用甘露醇较多(χ^(2)=78.614,P<0.001),CEA组切口/穿刺点并发症(χ^(2)=5.158,P=0.035)、肺部感染(χ^(2)=6.355,P=0.013)、脑过度灌注综合征(χ^(2)=5.158,P=0.035)、颅外神经损伤(χ^(2)=23.760,P<0.001)均多于CAS组,CAS组急性肾衰竭(χ^(2)=10.393,P=0.001)较多。术后两组存活率及术侧缺血性卒中、心肌梗死、脑出血、肾功能不全发生率差异均无统计学意义(均P>0.05),CAS组中位生存时间53.195个月(95%CI:52.040~54.350),CEA组中位生存时间54.492个月(95%CI:53.790~55.195),差异无统计学意义(P=0.051)。结论CEA组含有更多的不稳定斑块病变,却有更低的围手术期卒中率,支持不稳定斑块患者应倾向于内膜剥脱治疗。脑过度灌注综合征风险CEA组高于CAS组,CAS在减少术后肺部感染及伤口局部并发症方面显著优于CEA。两组患者远期生存率无显著差异。
Objective To compare carotid endarterectomy(CEA)and carotid artery stenting(CAS)in perioperative,medium and long term prognosis of patients with carotid artery stenosis.Methods A retrospective analysis was performed on 1329 cases of carotid artery stenosis treated at Department of Vascular Surgery,Beijing Anzhen Hospital from Jan 2011 to Aug 2020,as all cases being divided into CAS group and CEA group.Results There were significant differences in age(t=0.098,P=0.023)and drinking habits(χ^(2)=8.055,P=0.005)between the two groups.There were more unstable plaques in CEA group(χ^(2)=4.392,P=0.038),and more bilateral lesions in CAS group(χ^(2)=9.673,P=0.038).In perioperative period,there were more mannitol use in CEA group(χ^(2)=78.614,P<0.001),more incision/puncture site complications(χ^(2)=5.158,P=0.035),lung infection(χ^(2)=6.355,P=0.013),cerebral hyperperfusion syndrome(CHS)(χ^(2)=5.158,P=0.035)and extracranial nerve injury(χ^(2)=23.760,P<0.001)in CEA group than in CAS group,and more acute renal failure in CAS group(χ^(2)=10.393,P=0.001).There was no significant difference in survival rate and ischemic stroke,myocardial infarction,cerebral hemorrhage and renal insufficiency between the two groups(all P>0.05).The mean survival time of CAS group was 53.195 months(95%CI:52.040-54.350),and 54.492 months(95%CI:53.790-55.195)in CEA group(P=0.051).Conclusions Patients in CEA group had more unstable plaque and a lower perioperative stroke rate.CEA group had higher risk of CHS,while CAS was with lower postoperative lung infection rate and less wound local complications.There was no significant difference in long-term survival between the two groups.
作者
陈忠
杨耀国
唐小斌
寇镭
王盛
吴章敏
刘晖
何楠
张征
梁紫轲
张瀚方
Chen Zhong;Yang Yaoguo;Tang Xiaobin;Kou Lei;Wang Sheng;Wu Zhangmin;Liu Hui;He Nan;Zhang Zheng;Liang Zike;Zhang Hanfang(Center of Vascular Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)
出处
《中华普通外科杂志》
CSCD
北大核心
2022年第3期169-174,共6页
Chinese Journal of General Surgery
基金
中国脑卒中高危人群干预适宜技术研究及推广项目(GN-2018R0004)。
