Division of Vascular Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
Division of Vascular Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
Ann Vasc Surg. 2021 Feb;71:112-120. doi: 10.1016/j.avsg.2020.07.034. Epub 2020 Aug 5.
Cranial and cervical nerve (CCN) injury is recognized as a possible complication after carotid endarterectomy (CEA), which may result in minor local neurologic deficiencies and significant discomfort for the patient. The aim of this study is to investigate the effect of a mini-skin incision (<5 cm) on the CCN injury after CEA in comparison to standard longitudinal incision of 12-15 cm in a high volume center, and to evaluate health-related quality of life (HRQOL) outcomes in those patients who had undergone both types of the skin incision.
From January 2013 to December 2019, 446 CEAs (47.3%) were performed through a standard neck incision of 12-15 cm (group A), while 496 (52.7%) were performed through a mini-skin incision (<5 cm) (group B). Sixty-two patients underwent standard neck incision on one side and mini-skin incision on the other side (subgroup B). The main outcome measures were stroke, death, CCN injuries, cervical hematoma rates, and reinterventions. The HRQOL was assessed at baseline and after 30 days using Medical Outcomes Study Short-Form 36 and 6 disease-specific modified Likert scales.
The stroke and death rate at 30 days was 1.12% in group A and 1% in group B (P = 1). The incidence of CCN deficits was significantly lower in group B (5.1%) in comparison to group A (13.4%) (P < 0.001). The cervical hematoma was more common after standard incision (4.9% vs. 1.2%, P = 0.02). HRQOL at 1 month showed that the outcomes after mini-skin incision were significantly better for less difficulty with eating/swallowing and neck pain (P < 0.01).
CEA through a small incision (<5 cm) may reduce CCN complications without additional perioperative neurologic risks. As validated by patients with bilateral disease who experienced both surgical techniques, mini-skin incision is also associated with better HRQOL at 1 month, particularly with regard to eating/swallowing and neck pain.
颅神经和颈神经（CCN）损伤被认为是颈动脉内膜切除术（CEA）后的一种可能并发症，可能导致轻微的局部神经功能缺陷和患者的显著不适。本研究旨在探讨在高容量中心，与 12-15cm 的标准纵向切口相比，小切口（<5cm）对 CEA 后 CCN 损伤的影响，并评估接受这两种皮肤切口的患者的健康相关生活质量（HRQOL）结果。
2013 年 1 月至 2019 年 12 月，446 例 CEA（47.3%）采用 12-15cm 标准颈部切口（A 组）进行，496 例（52.7%）采用小切口（<5cm）（B 组）进行。62 例患者一侧采用标准颈部切口，另一侧采用小切口（亚组 B）。主要观察指标为卒中和死亡率、CCN 损伤、颈部血肿发生率和再介入治疗。使用医疗结局研究短式 36 项和 6 种疾病特异性改良利克特量表，在基线和 30 天后评估 HRQOL。
A 组和 B 组 30 天内的卒中和死亡率分别为 1.12%和 1%（P=1）。B 组 CCN 损伤发生率明显低于 A 组（5.1% vs. 13.4%，P<0.001）。标准切口后颈部血肿更常见（4.9%比 1.2%，P=0.02）。1 个月时的 HRQOL 结果显示，小切口（<5cm）术后吞咽和颈部疼痛困难程度明显降低（P<0.01）。
小切口（<5cm）CEA 可能减少 CCN 并发症，而不会增加围手术期神经风险。通过双侧疾病接受两种手术技术的患者验证，小切口还与 1 个月时更好的 HRQOL 相关，尤其是在吞咽和颈部疼痛方面。
