摘要目的 总结分期手术治疗双侧颈动脉中重度狭窄的临床经验.方法 回顾性分析2011年1月至2015年12月郑州大学第五附属医院分期手术治疗的双侧颈动脉中重度狭窄32例患者的临床资料.将患者分为两组,颈动脉内膜剥脱术(CEA)组21例患者行双侧CEA治疗,CEA+颈动脉支架成形术(CAS)组11例患者行分期CEA+CAS治疗.比较两组患者的手术效果、并发症情况及随访情况.结果 32例患者共实施CEA 53例次,CAS 11例次,所有手术均操作顺利,术后脑缺血状况得到明显改善,围术期内未出现死亡患者.分期双侧CEA组中,2例出现颈部血肿并感染,3例出现颅神经损伤症状,1例出现高灌注综合征.联合CEA+CAS组中,2例出现血流动力学抑制,1例出现心肌梗死.两组不良事件比较差异未见统计学意义(P>0.05).结论 分期手术治疗双侧颈动脉中重度狭窄安全、有效,个体化的手术方式选择对患者是有益的.

abstractsObjective To summarize the clinical experience of staged operation in the treatment of moderate and severe bilateral carotid stenosis .Methods The clinical data of 32 patients with bilateral moderate to severe bilateral carotid stenosis who underwent staged surgery in the Fifth Affiliated Hospital of Zhengzhou University from January 2011 to December 2015 were retrospectively analyzed .The patients were divided into two group:21 case in carotid endarterectomy (CEA) group had bilateral staged CEA , and 11 cases in carotid sterting ( CAS ) group had staged CEA +CAS.The surgical outcomes, complications and follow-up situation of the patients were compared .Results Thirty-two patients underwent carotid endarterectomy (CEA) 53 times and carotid stenting (CAS) 11 times.All operations were performed smoothly , the cerebral ischemia condition was improved significantly after operation , and no death occurred during the perioperative period .In stage CEA group , 2 cases had cervical hematoma and infection , 3 cases had cranial nerve injury symptoms and 1 case had hyperperfusion syndrome .In the combined CEA +CAS group, 2 cases had hemodynamic depression and 1 case had myocardial .There was no significant difference in adverse events between the two groups ( P>0.05 ) .Conclusions Stage operation is safe and effective on moderate and severe bilateral carotid stenosis , and individualized operation is beneficial to patients .