摘要
目的:比较补片式颈动脉内膜剥脱术（p-CEA）与外翻式颈动脉内膜剥脱术（e-CEA）的长期疗效。方法:回顾性分析2009年10月至2015年10月在北京协和医院血管外科接受颈动脉内膜剥脱术（CEA）治疗的颈动脉狭窄患者的临床资料（共计340例患者372例次手术，其中p-CEA为193例次，e-CEA为179例次），比较两种手术方式远期的全因死亡、心肌梗死、所有卒中及手术同侧卒中发生率，以及症状复发率。结果:2组基线结果比较显示，p-CEA组患者高脂血症比例高于e-CEA组，差异有统计学意义（46.1% vs 34.6%，P=0.032）。在133个月的随访期间，p-CEA组的病死率、心肌梗死发生率均高于e-CEA组，卒中发生率、手术同侧卒中发生率均低于e-CEA组，但差异均无统计学意义（17.8% vs 13.8%，P=0.4855；7.8% vs 5.9%，P=0.360；12.8% vs 15.6%，P=0.228；4.3% vs 5.9%，P=0.282）；2组在术后症状复发上，差异亦无统计学意义（χ2=0.198，df=15.622，P=0.85）。Kaplan-Meier分析显示，在第6年，2组之间术后再狭窄和术后死亡比较，差异无统计学意义（P=0.87；P=0.18）；在第8年，2组之间术后死亡和卒中比较，差异无统计学意义（P=0.34；P=0.24）。结论:p-CEA组和e-CEA组的远期死亡、心肌梗死、所有卒中和手术同侧卒中，以及术后症状复发等均无差异，均可作为治疗颈动脉狭窄的有效方法。
Abstract
Objective:To compare long-term outcomes of patch carotid endarterectomy (p-CEA) and eversion carotid endarterectomy (e-CEA).Methods:In a retrospective study, data on 340 patients (372 operations, p-CEA=193, e-CEA=179) who underwent carotid endarterectomy were collected between October 2009 and October 2015 in the Vascular Surgery Department of Peking Union Medical College Hospital. The long-term incidence of all-cause death, myocardial infarction, stroke, ipsilateral stroke, and recurrence of symptoms were compared between two groups during follow-up.Results:The comparison of baseline results showed that the proportion of patients with hyperlipidemia in the p-CEA group was higher than that in the e-CEA group (46.1% vs 34.6%, P=0.032). During a maximum follow-up period of 133 months, there was no statistical difference between the p-CEA group and the e-CEA group in mortality (17.8% vs 13.8%, P=0.4855), myocardial infarction (7.8% vs 5.9%, P=0.360), stroke (12.8% vs 15.6%, P=0.228), ipsilateral stroke (4.3% vs 5.9%, P=0.282), and recurrence of symptoms (χ2=0.198, df=15.622, P=0.85).Kaplan-Meier analysis showed that there was no significant difference in postoperative restenosis and postoperative death at year 6 between e-CEA and p-CEA groups (P=0.87; P=0.18), and postoperative death and stroke at year 8 between e-CEA and p-CEA groups (P=0.34; P=0.24).Conclusion:The adverse event rates in long-term follow-up showed no significant difference between the e-CEA and p-CEA groups. Both e-CEA and p-CEA are effective for carotid artery stenosis.
基金项目
中央保健基金(W2017BJ11)
国家重点研发计划项目(2020YFC2008003)
万方数据