Smith J L, Evans D H, Gaunt M E, London N J, Bell P R, Naylor A R
Department of Surgery, University of Leicester, UK.
Br J Surg. 1998 Jan;85(1):56-9. doi: 10.1046/j.1365-2168.1998.00551.x.
The aim of this study was to investigate whether the introduction of routine transcranial Doppler (TCD) ultrasonography during carotid endarterectomy reduces the incidence of microembolization by altering operative technique.
The number and nature of microemboli detected during the first 75 consecutive carotid endarterectomies performed with TCD monitoring during 1992-1993 (group 1) were compared with those in a similar series of 75 consecutive patients undergoing carotid endarterectomy in 1995 (group 2), after substantial experience (210 patients) with TCD monitoring. Emboli were classified as either particulate or gaseous.
In patients with evidence of particulate emboli during the dissection phase of the operation, the total number of particulate emboli fell significantly in patients in group 2 (P = 0.019). Similarly, in patients in whom microembolization was detected on immediate opening of the shunt, the total number of microemboli also fell significantly in group 2 (P = 0.003). Overall, the median (95 per cent confidence interval) number of particulate emboli detected during the entire procedure fell significantly from 21 (16-29) in group 1 to 9 (7-14) in group 2 (P = 0.0008).
TCD monitoring plays an important role in the training and quality control of carotid endarterectomy and helps significantly to reduce the amount of microembolization.
本研究旨在探讨在颈动脉内膜切除术期间引入常规经颅多普勒（TCD）超声检查是否通过改变手术技术来降低微栓塞的发生率。
将1992 - 1993年期间连续进行的75例在TCD监测下实施的颈动脉内膜切除术（第1组）过程中检测到的微栓子数量和性质，与1995年连续进行的75例类似颈动脉内膜切除术患者（第2组）的情况进行比较，后者是在积累了大量TCD监测经验（210例患者）之后。栓子分为颗粒状或气态。
在手术解剖阶段有颗粒状栓子证据的患者中，第2组患者的颗粒状栓子总数显著下降（P = 0.019）。同样，在分流立即开放时检测到微栓塞的患者中，第2组的微栓子总数也显著下降（P = 0.003）。总体而言，整个手术过程中检测到的颗粒状栓子中位数（95%置信区间）从第1组的21（16 - 29）显著降至第2组的9（７ - 14）（P = 0.0008）。
TCD监测在颈动脉内膜切除术的培训和质量控制中起着重要作用，并有助于显著减少微栓塞的发生量。
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