Wack C, Wölfle K D, Loeprecht H
Chirurgische Klinik, Zentralklinikum Augsburg.
Zentralbl Chir. 2000;125(3):251-8.
The intraoperative quality control in carotid surgery is performed by different methods: angiography, duplex-ultrasonography, transcranial Doppler ultrasonography, cw-Doppler, B-mode ultrasonography, pulsed Doppler with spectral analysis, angioscopy and flow-measurements. In Germany these measures are used only in one third of the carotid reconstructions. Especially with angiography and duplex-ultrasonography technical defects can be detected and differentiated if they were without clinical relevance like low-grade stenoses, small intima-flaps and residual plaques or needed to be reexplored. These are high-grade stenoses, acute thrombus-formations of the endarterectomised area and large intima-flaps. Abnormalities were detected in a mean of 17% of all carotid reconstructions by intraoperative control methods. In 5% severe irregularities lead to an immediate revision. Despite that there does not exist clear evidence whether the use of quality control methods reduces the perioperative neurological complication rate. It is not necessary to perform intraoperative quality control if meticulous operative technique with shunting and patch angioplasty is applied and a low perioperative complication rate is reached. For the documentation of the surgical result angiography can be recommended.
血管造影、双功超声、经颅多普勒超声、连续波多普勒、B 型超声、带频谱分析的脉冲多普勒、血管内镜检查和血流测量。在德国，这些措施仅在三分之一的颈动脉重建手术中使用。特别是通过血管造影和双功超声，如果存在像低度狭窄、小内膜瓣和残余斑块等无临床相关性的技术缺陷，或者需要再次探查的情况，如高度狭窄、动脉内膜切除区域的急性血栓形成和大内膜瓣，都可以检测并区分出来。通过术中控制方法，在所有颈动脉重建手术中平均有 17%检测到异常情况。其中 5%的严重异常导致立即进行修复。尽管如此，尚无明确证据表明使用质量控制方法是否能降低围手术期神经并发症发生率。如果采用细致的带分流和补片血管成形术的手术技术且围手术期并发症发生率较低，就没有必要进行术中质量控制。为记录手术结果，可推荐使用血管造影。
