摘要： 手术视频点击进入 目的 探讨颈动脉内膜切除术围手术期管理策略和临床疗效。方法 356 例颈动脉粥样硬化性重度狭窄（70% ~ 99%）患者共实施400例次（双侧狭窄44 例）颈动脉内膜切除术，分别采用标准式（120 例次）、外翻式（255 例次）和补片式（25 例次）术式，其中368 例次未行术中转流。结果 所有患者手术均获成功，12 例术后出现缺血性卒中（4 例）、脑出血（1 例）、声音嘶哑（1 例）、癫发作（2 例）、术后再闭塞（2 例）、再狭窄（1 例）和切口血肿（1 例）等并发症。术后随访1 ~ 36 个月，无一例出现脑卒中和其他严重并发症，患者生活质量明显改善。结论 成熟的医疗团队对颈动脉重度狭窄患者颈动脉内膜切除术治疗成功的意义至关重要。于围手术期密切监测患者病情变化，可有效预防术后并发症，对降低病死率、提高患者生活质量和延长寿命具有重要临床意义。

关键词: 颈动脉内膜切除术, 手术后并发症, 超声检查, 多普勒, 经颅

Abstract: Objective  Perioperative treatment strategies and clinical efficacy were discussed in this presentation when carotid endarterectomy (CEA) was performed for severe carotid artery stenosis patients.  Methods  CEA was underwent for 356 patients with severe carotid atherosclerotic stenosis in Department of Neurosurgery of Dalian Municipal Central Hospital from March 2009 to August 2013. Severe carotid artery stenosis (70%-99%) were diagnosed according to clinical manifestations and multiple tests, which included neck vascular Doppler ultrasound, transcranial Doppler ultrasonography (TCD), head and neck CTA or MRA, and so on. Forty-four of 356 patients suffered severe bilateral stenosis. Thus a total of 400 CEA was performed in 356 patients in this discussion. General anesthesia was applied. Among all of the CEA, 120 was operated in the standard approach; eversion carotid endarterectomy was underwent in 255 cases; membrane patch was used in 25 cases. Only 32 cases of 400 were adapted transit shunt.  Results  All of the operations were successful. Most of patients had significant improvements in clinical presentation. Imaging studies also revealed better cerebral blood flow or perfusion. Head lightness or dizziness were disappeared. Motor/sensory function and memory were improved in most cases. Postoperative complications were found in a total of 12 cases, including a few days of hoarseness in one case; small contralateral cerebral hemorrhage in one case; restenosis in one case; wound hematoma in one case; partial seizures in 2 cases; middle cerebral artery occlusion in 2 cases; contralateral cerebral infarction in 4 cases. The follow-up (1-36 months) showed most of complications were resolved.  Conclusions  A skillful, standard and experienced surgical team is important and essential for CEA. It is necessary to assess, monitor and treat perioperative patients closely, which may reduce surgical mortality, effectively prevent from occurrence of postoperative complications, and improve patients' quality of life after surgery.

Key words: Endarterectomy, carotid, Postoperative complications, Ultrasonography, Doppler, transcranial