[颈动脉内膜切除术后人工补片的价值]

[Value of the prosthetic patch after carotid endarterectomy].

作者信息

Ricco J B, Saliou C, Dubreuil F, Boin-Pineau M H

机构信息

Service de Chirurgie vasculaire, Hôpital Jean-Bernard, CHU Poitiers.

出版信息

J Mal Vasc. 1994;19 Suppl A:10-7.

PMID:8158065

Abstract

INTRODUCTION

Carotid patching after carotid endarterectomy remains a subject of controversy. However the recent medical literature shows that carotid patching lowers the incidence of both residual stenosis and early restenosis. Carotid patching seems also to lower the incidence of postoperative carotid occlusion. Some authors advocate systematic patching, others recommend a more selective use of carotid patching, among patients with small caliber carotid artery and among those with restenosis.

STUDY

We have realized this study to determine (1) the incidence of restenosis after direct closure in patients with internal carotid artery of more than 3.5 mm internal diameter, (2) the adequate size of the patch in carotid arteries of less than 3.5 mm interval diameter (3), the adequate material to use for carotid patching. To answer these questions, we have done a prospective study of 188 carotid endarterectomy comparing direct closure (Group A), saphenous patch (Group B), and prosthetic Gore-Tex patch (Group C) with randomization between saphenous and prosthetic patch.

RESULTS

In this study we were unable to show any difference among the three groups concerning postoperative mortality and neurologic complications. However we have been able to show more residual stenosis in group A than in groups B and C. One saphenous patch rupture occurred in Group B. After one year follow-up, five out of 43 restenosis occurred in Group A (11.6%). The rate of restenosis in groups B and C was 1.5% (2/135). In group B, six patients (8.7%) had a dilatation of the saphenous patch of more than 50% of their initial diameter.

CONCLUSIONS

In this study, carotid patch seems to lower the incidence of residual stenosis and early restenosis in small diameter internal carotid arteries. Carotid patching with a 5 mm diameter PTFE patch seems to be the ideal choice after carotid endarterectomy. Furthermore, prosthetic patching carry no risk of dilatation or rupture and spare the saphenous vein.

摘要

引言

颈动脉内膜切除术后进行颈动脉补片修补仍是一个有争议的话题。然而，近期医学文献表明，颈动脉补片修补可降低残余狭窄和早期再狭窄的发生率。颈动脉补片修补似乎还能降低术后颈动脉闭塞的发生率。一些作者主张系统性补片修补，另一些作者则建议在小口径颈动脉患者和再狭窄患者中更有选择性地使用颈动脉补片修补。

研究

我们开展这项研究以确定：（1）内径大于3.5 mm的颈内动脉患者直接缝合后再狭窄的发生率；（2）内径小于3.5 mm的颈动脉补片的合适尺寸；（3）用于颈动脉补片修补的合适材料。为回答这些问题，我们对188例颈动脉内膜切除术进行了前瞻性研究，比较直接缝合（A组）、大隐静脉补片（B组）和人工血管Gore-Tex补片（C组），大隐静脉补片和人工血管补片之间随机分组。

结果

在本研究中，我们未能显示三组在术后死亡率和神经并发症方面存在任何差异。然而，我们发现A组的残余狭窄比B组和C组更多。B组发生了1例大隐静脉补片破裂。经过一年的随访，A组43例再狭窄中有5例（11.6%）发生。B组和C组的再狭窄率为1.5%（2/135）。在B组中，6例患者（8.7%）大隐静脉补片扩张超过其初始直径的50%。