血管超声在颈动脉内膜切除术中的临床应用

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摘要目的探讨血管超声在颈动脉内膜切除术（CEA）中的临床应用价值。方法选择2013年3月～2015年1月在内蒙古医科大学附属医院神经外科拟行CEA手术的颈动脉粥样硬化性狭窄（狭窄率＞50%）患者51例，于术前、术中、术后6～8 h及7～10 d分别行颈动脉超声检查。二维图像显示管径、内中膜厚度、斑块大小及回声性状，彩色多普勒显示血流充盈情况及狭窄部位血流性状，频谱多普勒检测血流动力学改变。术前及术后7～10 d进行CT血管造影（CTA）。结果超声诊断颈动脉狭窄程度与手术结果比较，二者符合率为88.23%。超声评估斑块回声性状与手术结果一致性较高；51支颈动脉狭窄处流速术中、术后明显降低，与术前比较差异有统计学意义（P ＜ 0.05）；RI值均增高，差异有统计学意义（P ＜ 0.05）；术后51支血管中49支管腔增宽，血流通畅，2支血栓形成；超声与CTA对颈动脉狭窄的诊断有较高的一致性，符合率为76.48%；超声评价斑块回声性质明显优于CTA。结论血管超声在术前能够较准确地诊断颈动脉狭窄程度，了解斑块的回声特性及稳定性；术中监测颈动脉能降低手术过程中的并发症；术后复查可以评价手术效果，减少围术期脑卒中及术后再狭窄的发生率，降低患者致残率和致死率，对提高CEA成功率有重要意义。因此血管超声可以作为CEA术前筛查、术中监测、术后随访的首选方法。

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	付文艳李淑玲

关键词 ：血管超声, 颈动脉内膜切除术, 血流动力学, 侧支循环

Abstract：Objective To invastigate the clinical application value of vascular ultrasound in carotid endarterectomy (CEA). Methods Fifty-one patients with carotid atherosclerotic stenosis (stenosis rate was more than 50%) scheduled for CEA in Department of Neurosurgery of Affiliated Hospital of Inner Mongolia Medical University from March 2013 to January 2015 were selected. Carotid ultrasound was performed before operation, during operation and after operation for 6-8 hours and 7-10 days. Two dimensional images showed the diameter of the tube, the thickness of the inner membrane, the size of the plaque and the echo. The color Doppler showed the blood flow and the blood flow characteristics of the stenosis, and the changes of hemodynamics were detected by the frequency spectrum of Doppler. Computed tomographic angiography (CTA) was performed before surgery and 7-10 days after surgery. Results The coincidence rate of ultrasound diagnosis and surgical results of carotid artery stenosis was 88.23%. There was high consistency between ultrasound assessment of plaque echo characters and surgical results. The flow rates of carotid arteries stenosis in 51 cases were decreased significantly during operation and after operation, which showed statistically significant differences compared with that pre-operation (P ＜ 0.05); the RI value was increased, with significant difference (P ＜ 0.05); after operation, among 51 vessels, the lumen of 49 vessels was broadened, the blood flew was smooth, and 2 vessels had thrombosis. Ultrasound showed greater consistency to CTA in carotid artery stenosis, the coincidence rate was 76.48%; the plaque echo property evaluated by ultrasound was better than that of CTA. Conclusion Before operation, vascular ultrasound can helps to diagnose carotid stenosis degree accurately, and knows about the echo characteristics and stability of the plaque, intraoperative monitoring for carotid artery can reduce complications during operation; postoperative re-examination can evaluate the surgery effects, decrease the incidence of perioperative stroke and restenosis as well as disability rate and mortality, which has important significance to increase the success rate of CEA. Therefore, intravascular ultrasound can be as a priority for preoperative screening, intraoperative monitoring and postoperative follow-up of CEA.

Key words： Vascular ultrasound Carotid endarterectomy Hemodynamics Collateral circulation

基金资助:内蒙古自然科学基金项目（2014MS08108）。

通讯作者: 李淑玲（1973-），女，硕士，主任医师，主要从事超声诊断研究。

作者简介: 付文艳（1986-），女，硕士，主要从事超声诊断的研究。

引用本文:

付文艳李淑玲. 血管超声在颈动脉内膜切除术中的临床应用[J]. 中国医药导报, 2017, 14(22): 117-120.
FU Wenyan LI Shuling. Clinical application of vascular ultrasound in carotid endarterectomy. 中国医药导报, 2017, 14(22): 117-120.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2017/V14/I22/117

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