本文選題：頭頸部動(dòng)脈閉塞 + 血管內(nèi)介入治療�。� 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：慢性頭頸部動(dòng)脈閉塞是缺血性腦卒中的重要病因之一,導(dǎo)致了15%-25%的缺血性腦卒中,即使在最佳藥物治療方案的情況下,病變血管側(cè)2年內(nèi)發(fā)生缺血性卒中的風(fēng)險(xiǎn)仍能達(dá)到10%-15%。頭頸部動(dòng)脈閉塞的治療目前是一項(xiàng)世界性的難題,內(nèi)科藥物治療包括抗血小板聚集、抗凝、降血脂、控制血壓等。外科手術(shù)治療主要是單純頸動(dòng)脈內(nèi)膜剝脫術(shù)及顱內(nèi)外搭橋術(shù)。近年來隨著神經(jīng)介入材料及影像學(xué)的發(fā)展,血管內(nèi)介入開通術(shù)及雜交手術(shù)在臨床上開展起來。但目前學(xué)者間對(duì)于癥狀性頭頸部動(dòng)脈閉塞患者的手術(shù)治療尚存爭(zhēng)議,部分學(xué)者認(rèn)為由于頸動(dòng)脈閉塞患者手術(shù)技術(shù)難度大再通率低,術(shù)后并發(fā)癥多,風(fēng)險(xiǎn)高,不建議行開通術(shù)治療。另有一部分學(xué)者認(rèn)為在病例進(jìn)行嚴(yán)格篩選的情況下,對(duì)頸動(dòng)脈閉塞患者實(shí)施CEA是安全的,能獲得良好的中期通暢率及神經(jīng)功能恢復(fù),改善腦供血狀況。目的:研究頭頸部動(dòng)脈閉塞再通手術(shù)的適應(yīng)癥,探討再通術(shù)后并發(fā)癥及預(yù)防措施。方法:收集吉林大學(xué)第二醫(yī)院2015年1月~2016年12月期間收住院的11例頭頸部動(dòng)脈閉塞行再通術(shù)治療患者的臨床資料及隨訪資料,并結(jié)合相關(guān)文獻(xiàn)資料進(jìn)行分析。結(jié)果:男性患者7例(63.6%),女性4例(36.4%)。年齡50~75歲,平均為61.4歲。臨床癥狀主要表現(xiàn)為頭暈的患者2例,一側(cè)肢體活動(dòng)障礙4例,言語(yǔ)障礙伴一側(cè)肢體活動(dòng)不靈2例,視物不清2例,一過性意識(shí)不清1例�；颊呷朐汉�1-3日內(nèi)行頭頸部血管造影檢查(包括CTA、MRA、血管彩超)明確病變血管。其中,雙側(cè)ICA閉塞1例(9.1%),左側(cè)ICA閉塞6例(54.5%),左ICA合并右CCA閉塞1例(9.1%),單側(cè)VA閉塞2例(18.2%)。手術(shù)方式:血管內(nèi)介入開通術(shù)8例(72.7%)、雜交手術(shù)的3例(27.3%)。術(shù)后療效采用改良Rankin量表進(jìn)行評(píng)分。評(píng)分為0分的患者3例(27.3%);1分的2例(18.2%);2分的3例(27.3%);3分的2例(18.2%);6分的1例(9.1%)。結(jié)論:1、血管內(nèi)介入開通術(shù)及雜交手術(shù)治療頭頸部動(dòng)脈閉塞技術(shù)上可行。2、血管內(nèi)介入開通術(shù)及雜交手術(shù)能有效改善患者神經(jīng)功能障礙。
[Abstract]:Chronic head and neck artery occlusion is one of the important causes of ischemic stroke, resulting in 15 to 25% of ischemic stroke. Even under the best drug therapy, the risk of ischemic stroke in the diseased vascular side can reach 10 to 15 percent within 2 years. The treatment of head and neck artery occlusion is a worldwide problem. Medical treatment includes antiplatelet aggregation, anticoagulant, lowering blood lipid, controlling blood pressure, etc. The main surgical treatment is carotid endarterectomy and extracranial bypass grafting. In recent years, with the development of nerve interventional materials and imaging, intravascular interventional patency and hybrid surgery have been carried out in clinic. However, there are still controversies among scholars about the surgical treatment of symptomatic head and neck artery occlusion. Some scholars believe that because of the low rate of difficulty in the operation of the patients with carotid artery occlusion, there are many postoperative complications and high risk. Open surgery is not recommended. Some other scholars believe that under the condition of strict screening of patients with carotid artery occlusion, CEA is safe, can obtain a good medium-term patency rate and neural function recovery, and improve the cerebral blood supply. Objective: to study the indications of recanalization of head and neck artery occlusion and discuss the complications and preventive measures. Methods: the clinical data and follow-up data of 11 patients with recanalization of head and neck artery occlusion were collected from January 2015 to December 2016 in the second Hospital of Jilin University. Results: there were 7 males (63.6%) and 4 females (36.4%). The average age was 61.4 years. The main clinical symptoms were dizziness in 2 cases, motor disorder in one side in 4 cases, speech disorder with side limb inactivity in 2 cases, blurred vision in 2 cases, and transient confusion in 1 case. Head and neck angiography (including CTAM RAA, color Doppler ultrasound) was performed within 1-3 days after admission to identify the diseased vessels. Bilateral ICA occlusion was found in 1 case (9.1%), left ICA occlusion in 6 cases (54.5%), left ICA with right CCA occlusion in 1 case (9.1%) and unilateral VA occlusion in 2 cases (18.2%). The operative methods were as follows: 8 cases (72.7%) underwent intravascular interventional surgery and 3 cases (27.3%) underwent hybrid surgery. The postoperative efficacy was evaluated by modified Rankin scale. There were 3 patients with 0 score (27.3%), 2 patients with 1 score (18.2%), 3 patients with 2 scores (27.3%), 2 patients with 3 scores (18.2%) and 1 patient with 6 scores (9.1%). Conclusion: the technique of intravascular interventional operation and hybrid surgery for the treatment of head and neck artery occlusion is feasible. Intravascular interventional patency and hybrid surgery can effectively improve the neurological dysfunction of the patients.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3

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