Schröder J, Omlor G
Klinik für Allgemeine, Visceral- und Gefässchirurgie Kathol. Kliniken Essen-Nord Marienhospital Altenessen Hospitalstr. 24 45329 Essen.
Z Kardiol. 2000;89 Suppl 8:14-8.
In a retrospective study we examined the possible of obtaining better results with a new operation technique of the carotid artery, the so-called "no-touch isolation" in comparison with conventional operation technique.
49 patients, who had been operated in 1997 and 1998 by this new operation technique, were compared with a group of 39 patients, who had been previously operated with the conventional technique. The new "no-touch isolation" technique is aimed at avoiding possible intraoperative and postoperative embolies. First, the carotis internal artery was exposed and clamped distal to the stenotic plaque very atraumatically. The operation was further carried out without the use of an intraluminal shunt. At the end of the procedure the operation results were checked by means of an intraoperative angiography. In case of a possible embolization source, like pieces of intima, an intraoperative revision was carried out until all embolization material was removed.
The two compared groups were not different regarding age, sex, symptomatology, degree of stenosis, and risk factors. No significant differences in context with the applied operation method for TEA (with or without patch, Eversions-TEA, etc.) could be detected. The group operated with the "no-touch isolation" technique had significantly longer operationtimes and also significantly longer clampingtimes than the group operated with the conventional technique. However, the postoperative results were better. Significantly fewer neurological deficits appeared and, in addition significantly fewer patients had to be revised because of secondary hemorrhages.
The "no-touch isolation" technique is, at the moment, the best surgical procedure for the carotid artery. It is the method of choice for patients with symptomatic stenosis of the internal carotid artery with more than 70% stenotic degree.
在一项回顾性研究中，我们检验了与传统手术技术相比，采用一种新的颈动脉手术技术（即所谓的“无接触分离”技术）是否有可能获得更好的效果。
将1997年和1998年采用这种新手术技术进行手术的49例患者与一组先前采用传统技术进行手术的39例患者进行比较。新的“无接触分离”技术旨在避免可能的术中和术后栓塞。首先，非常轻柔地暴露颈内动脉并在狭窄斑块的远端进行夹闭。手术进一步在不使用腔内分流器的情况下进行。在手术结束时，通过术中血管造影检查手术结果。如果存在可能的栓塞源，如内膜碎片，则进行术中修正，直至所有栓塞物质被清除。
两组在年龄、性别、症状、狭窄程度和危险因素方面没有差异。在应用的TEA手术方法（有无补片、外翻式TEA等）方面未检测到显著差异。采用“无接触分离”技术进行手术的组比采用传统技术进行手术的组手术时间明显更长，夹闭时间也明显更长。然而，术后结果更好。出现的神经功能缺损明显更少，此外，因继发性出血而必须进行修正的患者也明显更少。
“无接触分离”技术目前是颈动脉手术的最佳手术方法。它是颈内动脉症状性狭窄程度超过70%的患者的首选方法。
