摘要
目的总结复合手术治疗椎动脉闭塞的策略和手术疗效。方法回顾性分析1例由深圳市第二人民医院神经外科血管病区收治的椎动脉慢性闭塞患者的临床资料,经脑血管造影检查发现右侧椎动脉近端闭塞,左侧椎动脉中段闭塞。采用传统椎动脉内膜剥脱术联合血管内介入支架植入术开通一侧闭塞椎动脉。术后定期随访。结果通过复合手术(先行颈部椎动脉血管切开和内膜剥脱,后行介入支架植入术)顺利开通一侧闭塞椎动脉(椎动脉近端闭塞侧),术后患者各项临床表现明显较术前有所改善,术后1个月、3个月、术后半年以及术后1年均返院复查头颈部CT血管造影,提示复合手术治疗-侧椎动脉闭塞再通良好,血管通畅。术后随访提示患者各项临床表现也明显较术前有所好转。结论对于椎动脉近端闭塞患者,进行复合手术治疗既能从根本上剥离闭塞椎动脉内膜,也能通过植入支架支撑血管,防止血管二次闭塞,比传统单纯椎动脉内膜剥脱或单纯介入支架植入术有更明显优势,手术效果良好。
Objective To summarize the strategy and surgical efficacy of hybrid surgery for vertebral artery occlusion.Methods A retrospective analysis of the clinical diagnosis of a patient with right proximal vertebral artery occlusion,left middle vertebral artery occlusion,and initial stenosis which was found by cerebral angiography in the Neurosurgery Vascular Ward of Shenzhen Second People's Hospital.Traditional vertebral endarterectomy combined with interventional vertebral artery occlusion and stenting was used to open one side of the occluded vertebral artery,and regular postoperative follow-up was performed.Results Through hybrid surgery(first cervical vertebral artery vascular incision and endarterectomy,followed by interventional stent implantation),one side of the occluded vertebral artery(the proximal vertebral artery occlusion side)was successfully opened,and the postoperative clinical manifestations of the patients were significantly improved.The preoperative improvement was improved,and the head and neck computer technology angiography examinations at 1 month,3 months,half a year and even one year after the operation indicated that the lateral vertebral artery occlusion was well recanalized and the vertebral artery blood vessels were unobstructed.Postoperative follow-up showed that the clinical manifestations of the patients were also significantly improved compared with those before surgery.Conclusion For patients with proximal vertebral artery occlusion,hybrid surgery can not only fundamentally strip the intima of the occluded vertebral artery,but also support the blood vessel by inserting a stent to prevent the risk of secondary occlusion of the blood vessel.Compared with simple interventional stent implantation,it has obvious advantages,and this surgical method has good surgical outcomes during follow-up.
作者
陆东生
桂建康
范衍
刘春林
李祉岑
宫崧峰
Dongsheng Lu;Jiankang Gui;Yan Fan;Chunlin Liu;Zhicen Li;Songfeng Gong(Department of Neurosurgery,Shenzhen Second People's Hospital,Shenzhen 518035,China)
出处
《中华脑血管病杂志（电子版）》
2023年第4期386-393,共8页
Chinese Journal of Cerebrovascular Diseases(Electronic Edition)
基金
深圳市第二人民医院临床研究项目(20223357038)。
关键词
椎动脉闭塞
复合手术
内膜剥脱术
支架植入术
Vertebral artery occlusion
Hybrid surgery
Endarterectomy
Stent implantation
