Donato A T, Hill S L
Department of Surgery, Community Hospital of Roanoke Valley, Virginia.
Am Surg. 1992 Aug;58(8):446-50.
Carotid endarterectomy has recently become one of the more controversial operations. The tremendous increase in the number of endarterectomies performed, coupled with the apparent increase in morbidity and mortality associated with this operation in some studies, have brought into question the indications and results of the procedure. The potential for complications from the procedure itself, as well as increased morbidity and mortality from surgery on the elderly, make carotid endarterectomy a dangerous operation that must be done carefully and thoughtfully. The authors have performed carotid endarterectomies exclusively under local anesthesia to more closely evaluate the neurologic status of the patient. They believe that the operation performed in this manner obviates the use of a shunt and its inherent complications in greater than 80 per cent of the patients. This, coupled with the fact that many of the patients also have severe cardiac disease and the use of local anesthesia causes less hemodynamic changes and stress, should make carotid endarterectomy under local anesthesia the preferred approach.
颈动脉内膜切除术近来已成为争议较大的手术之一。所施行的内膜切除术数量大幅增加，再加上一些研究中该手术相关的发病率和死亡率明显上升，使得该手术的适应症和效果受到质疑。该手术本身存在并发症的可能性，以及老年患者手术导致的发病率和死亡率增加，使得颈动脉内膜切除术成为一项必须谨慎、周全进行的危险手术。作者仅在局部麻醉下进行颈动脉内膜切除术，以更密切地评估患者的神经状态。他们认为，以这种方式进行手术可使超过80%的患者无需使用分流管及其固有并发症。再加上许多患者还患有严重心脏病，且使用局部麻醉引起的血流动力学变化和应激较小，这应使局部麻醉下的颈动脉内膜切除术成为首选方法。
