Clinical Study Of Modified Longitudinal Small Incision For Carotid Endarterectomy

Background: Stroke has become the leading cause of death among urban and rural residents in China.About 80% of stroke patients are cerebral ischemic stroke,and 25% to 30% of cerebral ischemic stroke is closely related to carotid stenosis.Now carotid endarterectomy is the gold standard for the treatment of carotid stenosis,which is highly safe and effective.In order to expose the bifurcation of the carotid artery and the distal end of the internal carotid artery,scholars often use the neck long incision for conventional carotid endarterectomy(cCEA),but the surgical incision is closely related to the occurrence of postoperative complications and the quality of life of patients.It is reported that cCEA has high incidence of cranial and cervical nerve lesions and longer operation time and poor cosmetic effect.With the development of society,patients and their families have higher expectations for surgery,and they want the incision to be as beautiful as possible with fewer complications.Small incisions gradually come into the field of vision of neurosurgery experts.In the past,the research on CEA with small incision is mostly focused on the transverse incision,but the research on the longitudinal small incision is less,so the clinical effect of the modified longitudinal small incision for carotid endarterectomy(mCEA)is worth discussing in this subject.Objective: To explore whether mCEA can achieve the clinical effect of complete removal of plaque and relieving artery stenosis by comparing with cCEA,and to explore whether mCEA has the advantages of reducing the incidence of postoperative complications(stroke?death?nerve lesions?incision hematoma)and shortening operation time and reducing incision pain and increasing patients' satisfaction when it is used in the treatment of carotid artery stenosis.Methods: The clinical data of 33 patients who underwent carotid endarterectomy in the department of Neurosurgery of Guangzhou First People's Hospital from March 2016 to March 2019 were retrospectively analyzed.They were divided into two groups(mCEA group and cCEA group)according to the length of the incision.The general clinical data and postoperative cranial and cervical nerve lesions and stroke/death and incision hematoma and operation time and plaque length and postoperative wound pain score and satisfaction of incision and recovery of nerve lesions were statistically analyzed between the two groups.Results: There was no stroke between the two groups.There was no significant difference among the incidence of death and the cranial nerve and cervical lesions and the length of excised plaque between the two groups(P>0.05).The operation time and the incidence of incision hematoma and postoperative wound pain score in mCEA group were significantly better than those in cCEA group(P<0.05).Most of the postoperative nerve lesions were temporary and recovered within half a year.The patients were more satisfied with the postoperative incision in the mCEA group.Conclusion: mCEA is safe and effective.Compared with cCEA,mCEA does not increase the incidence of cranial and cervical nerve lesions and death.mCEA has the advantages of low incidence of subcutaneous hematoma and short operation time and low postoperative pain score and patients' satisfaction with incision,so it is worth popularizing and applying.The use of shunt may be related to the high incidence of nerve injury,which needs further study.