| Objective: As the accelerated process of aging society in China,stroke has gradually become one of the main causes of death,and the rate is increasing in 8.7% per year.Its 30 % mortality and 70% disability rate has brought a heavy burden to the patients and the community.Since De Bakey carried out to cut off carotid artery intimal resection(CEA)in 1953,it has been proved to be an effective method for the treatment of carotid atherosclerotic stenosis and the prevention of ischemic stroke for 65 years.The promotion of CEA in our country is later,however,it is developing rapidly.CEA has been widely used in lots of tertiary hospitals,which is the best standard for the treatment of carotid artery stenosis at present.This procedure is generally divided into three methods,which are standard carotid artery intimal stripping(s CEA),external carotid artery intimal stripping(e CEA)and carotid angioplasty and stenting(p CEA).Meanwhile,e CEA and p CEA are the "mainstream" modes.Which one is better yet inconclusived,there are several arguments about postoperative restenosis,surgical infection,medical costs.The article reviewed that the comparative analysis of the clinical correlation of two types,it assess the clinical value of the two kinds of operation and constantly optimize the selection criteria,so as to improve the rehabilitation effect of cerebral apoplexy patientsMethods: There are 87 patients which received the treatment(carotid endar-terectomy operation)in the Department of Neurosurgery the First Affiliated Hospital of Soochow University from January 2013 to April 2016 in this study.All patients received imaging examinations such as TCD(transcranial Doppler),CT(Computed Tomography),CTA(Computed Tomography angiography),CTP(Computed Tomography perfusion imaging)and so on,before operation,and the rate of carotid artery stenosis is according to the North American Symptomatic Carotid Endarterectomy Trial standard.After preoperative anesthesia,the incision of patients is chose on the the front region of sternocleidomastoid muscle,then expose the carotid sheath,dissociate internal,external and common carotid artery.In this process,more attention should be paid to the protection of the tongue nerve,and the flow tube could be used in cerebral blood supply insufficiency.According to the operation,the patients were divided into observation group and control group,the observation group adopted e CEA operation,which has 56 cases,52 males and 4 females,with the average age at 68.09±0.99 y.Operation steps: there is an oblique incision in the carotid bifurcation of internal carotid artery,and strip thickened intima in internal carotid artery,carotid artery and carotid artery branch under the microscope.If there is a floating state in the distal intima of the patient,it should be suture fixation,using 7-0 or other vascular suture without damage to the internal carotid and common carotid artery.In the control group,there are 31 cases,26 males and 5 females,with the average age at 69.71±1.34 y.Operation steps: longitudinal incise internal carotid artery and common carotid artery,remove Carotid artery intima and plaque,clean floating intima and broken skin,then mend vascular wall with artificial patch pruning using 7-0 vascular sutures.There are compared between two groups on gender,ages,symptom,disease risk factors,the degree of carotid stenosis,postoperative complications,utilization tatio of antibiotics,hospital fees;hospital stay.The SPSS19.0 statistical software is applied to analyze and process these data,meanwhile,χ2 and t test indicate statistical significance.Results: The p CEA group used conventional artificial patch,so the utilization rate of antibiotics were significantly higher than those in group e CEA(P < 0.05),and there are 2 cases of patients who appears infection after p CEA operation.These factors led directly to the study group(e CEA group)less than the control group(p CEA group)about utilization tatio of antibiotics,hospital fees;hospital stay,and there is significant difference between two groups(P < 0.05).However,there was no significant difference between the two groups(P > 0.05)in terms of operative complication and restenosis.Comparison of p CEA operation,the p CEA operation has the following advantages: no need of patch,avoiding patch infection,reducing the usage of antibiotics,less hospital fees and hospital stay.But,there is no significant difference on surgical efficacy and safety between them.Therefore,in the treatment of carotid stenosis,e CEA should be given priority selection to the patients at the same conditions.It may be in accordance with the principle of " bargain ". |
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