摘要： 目的 探讨颈动脉粥样硬化性狭窄患者行颈动脉内膜切除术并Ⅰ期缝合的治疗效果。方法 共65 例颈动脉粥样硬化性狭窄患者，左侧狭窄35 例（53.85%）、右侧30 例（46.15%）；据北美症状性颈动脉内膜切除术试验标准，中度狭窄17 例（26.15%）、重度狭窄48 例（73.85%），均行颈动脉内膜切除术，观察术后并发症和预后。结果 所有患者均手术顺利，手术成功率达100%，平均手术时间90 min，均未使用转流管，颈动脉平均阻断时间30 min，均未使用补片，达Ⅰ期缝合。术后临床症状均改善，其中1 例术后出现对侧肢体肌力下降、感觉麻木，对症治疗1 周后恢复出院；1 例喉返神经损伤、1 例舌咽神经损伤，均于术后6 个月恢复；1 例术后12 个月颈动脉再狭窄率> 50%，但无症状临床，予保守治疗；1 例术后4 个月突发急性心肌梗死，急诊入院后经对症治疗恢复；1 例术后9 个月死亡，原因不明。无一例发生缺血性卒中。结论 充分的术前准备、密切的术中监测、精细的手术操作，以及术后严密观察可以保证颈动脉内膜切除术的治疗效果。

关键词: 颈动脉内膜切除术, 颈动脉狭窄, 动脉粥样硬化

Abstract: Objective  To discuss the therapeutic effect of carotid endarterectomy (CEA) for patients with carotid atherosclerotic stenosis.  Methods  A total of 65 patients with carotid atherosclerotic stenosis were enrolled. There were 35 cases of left stenosis (53.85%) and 30 cases of right stenosis (46.15%). According to North American Symptomatic Carotid Endarterectomy Trial (NASCET), there were 17 cases of moderate stenosis (26.15%) and 48 cases of severe stenosis (73.85%). All of them underwent CEA, and the postoperative complications and prognosis were observed and assessed.  Results  CEA was successfully performed in 65 patients with a mean operation time of 90 min and a mean carotid blocking time of 30 min. There was no use of carotid patch and no intraoperative shunting. After CEA, the clinical symptoms of all patients were improved. Postoperative complications were as follows: one patient presented muscle weakness and numbness of contralateral extremities, and recovered after one-week symptomatic treatment; cranial nerve injury occurred in 2 cases: one recurrent laryngeal nerve injury and the other glossopharyngeal nerve injury, however, all injuries were transient and were cured 6 months after the operation; one case presented restenosis of ipsilateral carotid without clinical symptom and thus received conservative treatment; one case suffered from acute myocardial infarction 4 months after the operation, and recovered after symptomatic treatment; one case died without clear cause of death 9 months after the operation. None of these patients occurred with ischemic stroke. Conclusions  Full preoperative preparation, close monitoring and meticulous manipulation during operation, frequent postoperative observation and treatment can ensure the treatment effect of CEA.

Key words: Endarterectomy, carotid, Carotid stenosis, Atherosclerosis