Voskanian Iu E, Kolomeĭtsev S N, Shniukov R V
Angiol Sosud Khir. 2005;11(2):96-103.
Reconstructive operations on aortic arch branches is the most effective approach to prevention of acute and chronic disorders of cerebral circulation. Iatrogenic injuries to the cranial nerves worsen the early end, particularly, the late postoperative period, decrease the quality of life and the social status of patients who had undergone carotid reconstructions. The aim of the study was to improve the short- and long-term results of reconstructive operations on the carotid arteries by means of minimizing the incidence and severity of iatrogenic injuries to the cranial nerves. The study accrued 149 patients undergoing operations on the carotid arteries for atherosclerosis or pathologic tortuosity. Of these 82 patients forming the control group were examined for the incidence and character of injuries to the cranial nerves. Neuropathy of the cranial nerves (CN) was identified in 16 (19.5%) patients (7 patients had injuries to the hypoglossal nerve, 3 to the facial nerve, 5 to the vagus; one patient presented with coexistent injury to the glossopharyngeal and pharyngeal branches of the vagus). The clinically and statistically significant risk factors of injuries were: minor surgical experience, the high loop of the internal carotid artery (ICA), lengthy atherosclerotic stenosis greater than 2 cm, diabetes mellitus, intraoperative trauma of the area of the cranial nerves, high mobilization of the ICA, the lack of visualization of pairs X and XII of the CN, intraoperative bleeding, intersection of the superior radix of the deep cervical loop, edema and hematoma of the neck in the postoperative period, and early unscheduled reoperations. One month later the cumulative stability of cranial dysfunction accounted for 62.5%, after 3 months it accounted for 43.8%, after 6 months for 31.2 , after 9 months for 18.8%, and after 12 months for 6,2%. In patients with injury to the CN, analysis of the quality of life made in the late postoperative period revealed its lowering with respect to all the constituents of mental and physical health. Multimodality prevention of CN injuries was carried out in 67 basic group patients and was aimed at exclusion or abatement of the intensity of the impact of the removable risk factors. The proposed measures made it possible to minimize the incidence of CN injuries from 19.5 to 4.5% and to appreciably improve the quality of life of operated patients.
主动脉弓分支的重建手术是预防脑循环急慢性疾病的最有效方法。医源性颅神经损伤会使早期结局恶化，尤其是术后晚期，会降低接受颈动脉重建手术患者的生活质量和社会地位。本研究的目的是通过尽量减少医源性颅神经损伤的发生率和严重程度，来改善颈动脉重建手术的短期和长期效果。该研究纳入了149例因动脉粥样硬化或病理性迂曲而接受颈动脉手术的患者。其中82例组成对照组，检查颅神经损伤的发生率和特征。在16例（19.5%）患者中发现了颅神经病变（7例舌下神经损伤，3例面神经损伤，5例迷走神经损伤；1例患者同时存在迷走神经舌咽支和咽支损伤）。损伤的临床和统计学显著危险因素包括：手术经验少、颈内动脉高位袢、长度大于2 cm的冗长动脉粥样硬化狭窄、糖尿病、颅神经区域的术中创伤、颈内动脉的高游离度、无法看清第X和第XII对颅神经、术中出血、颈深袢上根交叉、术后颈部水肿和血肿以及早期非计划再次手术。1个月后颅神经功能障碍的累积稳定性为62.5%，3个月后为43.8%，6个月后为31.2%，9个月后为18.8%，12个月后为6.2%。在颅神经损伤的患者中，术后晚期对生活质量的分析显示，其在心理和身体健康的所有方面均有所下降。对67例基础组患者实施了多模式颅神经损伤预防措施，旨在排除或减轻可消除危险因素的影响强度。所提出的措施能够将颅神经损伤的发生率从19.5%降至4.5%，并显著改善手术患者的生活质量。
