Zannetti S, Parente B, De Rango P, Giordano G, Serafini G, Rossetti M, Cao P
Unit of Vascular Surgery, Policlinico Monteluce, Perugia, Italy.
Eur J Vasc Endovasc Surg. 1998 Jun;15(6):528-31. doi: 10.1016/s1078-5884(98)80114-7.
To establish the incidence of cranial and cervical nerve injuries during CEA and their relationship to different surgical techniques and operative findings.
A prospective study.
From January 1994 to April 1995, 187 consecutive patients undergoing 190 CEAs were evaluated. Pre- and postoperative cranial and cervical nerve assessments were carried out by a single otolaryngologist, blinded to the operative technique and findings. Deficits lasting more than 12 months were defined as permanent. Logistic regression analysis was performed to evaluate the influence of surgical technique, type of anaesthesia, neck haematoma, and plaque extension on the onset of nerve injuries.
Postoperatively, nerve lesions were identified in 51 CEAs (27%) and non-neurological injuries (hemilaryngeal ecchymosis or oedema) causing postoperative dysphonia were present in 80 CEAs (42%). All non-neurological injuries were transient and 98% disappeared within 1 month of surgery. Thirteen (7%) nerve lesions were permanent, but none were disabling. Vagus nerve lesions were significantly associated with long (> 2 cm) carotid plaque (OR = 3.5; CI 1.09-12.37; p = 0.03). Cervical branch lesions were associated with the presence of neck haematoma (OR = 1.9; CI 0.7-4.7; p = 0.05). The incidence of single cranial nerve injuries was higher in patch (OR = 2.7) and eversion (OR = 1.9) procedures than in primary closure. Multiple deficits (2 or more) were most frequent in eversion CEAs (OR = 2.8) and in cases complicated by neck haematoma (OR = 3.8).
Cranial and cervical nerve lesions during CEA are common. However, our data showed that the majority of local complications are related to transient hemilaryngeal ecchymosis or oedema and, when permanent, are neither clinically relevant nor disabling at 1 year of follow up. Carotid plaque extension and neck haematoma appear to increase the incidence of cranial and cervical nerve lesions during CEA.
确定颈动脉内膜切除术（CEA）期间颅神经和颈神经损伤的发生率及其与不同手术技术和手术发现的关系。
一项前瞻性研究。
1994年1月至1995年4月，对连续187例行190次CEA手术的患者进行评估。术前和术后由一名耳鼻喉科医生进行颅神经和颈神经评估，该医生对手术技术和发现不知情。持续超过12个月的神经功能缺损被定义为永久性缺损。进行逻辑回归分析以评估手术技术、麻醉类型、颈部血肿和斑块延伸对神经损伤发生的影响。
术后，51例CEA（27%）发现神经损伤，80例CEA（42%）出现导致术后声音嘶哑的非神经损伤（半侧喉瘀斑或水肿）。所有非神经损伤均为短暂性，98%在术后1个月内消失。13例（7%）神经损伤为永久性，但均无功能障碍。迷走神经损伤与长（>2 cm）颈动脉斑块显著相关（比值比[OR]=3.5；可信区间[CI]1.09 - 12.37；p = 0.03）。颈支损伤与颈部血肿的存在相关（OR = 1.9；CI 0.7 - 4.7；p = 0.05）。补片（OR = 2.7）和外翻（OR = 1.9）手术中单根颅神经损伤的发生率高于一期缝合。多根神经功能缺损（2根或更多）在外翻CEA（OR = 2.8）和并发颈部血肿的病例中最为常见（OR = 3.8）。
CEA期间颅神经和颈神经损伤很常见。然而，我们的数据表明，大多数局部并发症与短暂性半侧喉瘀斑或水肿有关，永久性损伤在随访1年时既无临床相关性也无功能障碍。颈动脉斑块延伸和颈部血肿似乎会增加CEA期间颅神经和颈神经损伤的发生率。
