Dahl T, Aasland J, Romundstad P, Johnsen H J, Myhre H O
Department of Surgery, St. Olavs Hospital, Institute of Circulation and Medical Imaging, University Hospital of Trondheim, Trondheim, Norway.
Int Angiol. 2006 Sep;25(3):241-8.
The aim of this study was to evaluate the results following surgery for carotid artery stenosis in a single institution during a 20-year period.
In a retrospective study, 556 operations were performed in 496 patients during the period 1983-2002. Comorbidities, mortality, stroke and other surgical and general complications were recorded. Follow-up was performed and data retrieved from medical records, questionnaires, and visits to local hospitals. Data on late mortality were retrieved from the Norwegian Registrar's Office of birth and deaths.
The mean age was 66.9 years (range 43-84 years), and 60% were men; 84% had symptomatic carotid artery stenosis. General anesthesia was applied in 95.5%. A shunt was used in 61.3%, and patch angioplasty in 95.1%. Autologous vein patch was used in almost all cases and there were no cases of patch rupture. Postoperative myocardial infarction occurred in 16 (2.9%) of the patients, and 5 were fatal. All types of stroke within 30 days of surgery occurred in 23 (4.1%) including 1 fatal stroke, and 7 patients died of other causes. The total stroke/mortality rate was 5.4%. Patients with previous coronary artery bypass had a favorable outcome regarding long-time survival. In contrast, increasing age, diabetes, renal failure and intermittent claudication predicted reduced long-term survival. No operations were performed for recurrent stenosis.
We have used fairly the same policy regarding operative technique during the 20-year period and the results are in agreement with those presented in large international trials. The long-term results were favorable, and improved over time, probably due to better preoperative evaluation of the patients, better timing of surgery and treatment of comorbidities.
本研究旨在评估一家机构在20年期间内对颈动脉狭窄进行手术后的结果。
在一项回顾性研究中，1983年至2002年期间对496例患者进行了556例手术。记录了合并症、死亡率、中风以及其他手术和一般并发症。进行了随访，并从病历、问卷以及对当地医院的访视中获取数据。关于晚期死亡率的数据从挪威出生和死亡登记处获取。
平均年龄为66.9岁（范围43 - 84岁），60%为男性；84%有症状性颈动脉狭窄。95.5%采用全身麻醉。61.3%使用了分流管，95.1%进行了补片血管成形术。几乎所有病例都使用了自体静脉补片，没有补片破裂的病例。16例（2.9%）患者发生术后心肌梗死，其中5例死亡。术后30天内各种类型的中风发生在23例（4.1%），包括1例致命性中风，7例患者死于其他原因。总中风/死亡率为5.4%。既往有冠状动脉搭桥手术的患者在长期生存方面有良好的结果。相比之下，年龄增加、糖尿病、肾衰竭和间歇性跛行预示着长期生存率降低。没有对复发性狭窄进行手术。
在这20年期间，我们在手术技术方面采用了相当一致的策略，结果与大型国际试验的结果一致。长期结果良好，并且随着时间推移有所改善，这可能归因于对患者更好的术前评估、更好的手术时机选择以及合并症的治疗。
