摘要： 目的 探讨颈动脉内膜切除术治疗颈动脉狭窄的手术技巧，提高手术疗效，降低术中不良事件及术后并发症发生率。方法 共53 例颈动脉狭窄患者，右侧狭窄26 例、左侧15 例、双侧12 例；中度狭窄（30% ~ 69%）35 例、重度狭窄（70% ~ 99%）16 例、完全闭塞2 例。结果 其中50 例单纯行颈动脉内膜切除术、2 例行颈动脉内膜切除术联合动脉瘤夹闭术、1 例颈动脉支架成形术后管腔狭窄者行颈动脉内膜切除术并支架取出术。术后颈部CTA 及灌注成像提示颈动脉血管形态良好、血流通畅，脑组织灌注不同程度改善。随访3 ~ 24 个月，1 例因心肌梗死死亡、2 例术侧颈部皮肤麻木、1 例声音嘶哑、3 例仍有轻度短暂性脑缺血发作，无脑卒中病例。结论 颈动脉内膜切除术是治疗颈动脉狭窄性病变安全、有效的外科方法，正确选择手术适应证及娴熟的手术技巧是保证手术成功、提高疗效的关键。

关键词: 颈动脉狭窄, 颈动脉内膜切除术, 体层摄影术, X 线计算机

Abstract: Objective To investigate the surgical techniques of carotid endarterectomy (CEA) for treating carotid artery stenosis, in order to improve the surgical efficacy and reduce intraoperative adverse events and complications after operation.  Methods  Retrospective analysis was carried out on surgical data of 53 cases who were performed CEA from October 2010 to October 2013 in Department of Neurosurgery in Tianjin Huanhu Hospital. There were 39 males and 14 females, aged from 40 to 78 years old and mean age (60.34 ± 8.92) years old; the course of disease was from 2 d to 4 years. Twenty-six cases were diagnosed as right carotid stenosis, 15 cases left carotid stenosis and 12 cases double-sided carotid stenosis. Among all of those cases, 35 cases were diagnosed as moderate stenosis (30%-69%), 16 cases severe stenosis (70%-99% ), and 2 cases complete occlusion.  Results  Among 53 patients, 50 patients underwent CEA; 2 cases underwent CEA and aneurysm clipping; one case underwent stent removal surgery and CEA because restenosis was found after carotid artery stenting (CAS). Postoperative neck CTA and fMRI showed good morphology of carotid artery, fluent blood flow and improved cerebral perfusion after operation. All of those patients were followed up for 3 to 24 months. One case died of myocardial infarction; 2 cases appeared skin numbness on the operating side of the neck, and the symptom disappeared 3 months later; one case appeared hoarseness after operation; 3 cases experienced mild transient ischemic attack (TIA) and the symptom disappeared 2 months later. No case of stroke was found.  Conclusions  CEA is a safe and effective surgical approach to treat carotid stenosis. Correct and reasonable choices of the surgical indications and skilled surgical technique are the key to ensure the success of operation and to improve efficacy of the therapy.

Key words: Carotid stenosis, Endarterectomy, carotid, Tomography, X-ray computed