Kết quả dài hạn điều trị hẹp động mạch ngoài sọ bằng phẫu thuật bóc lớp trong động mạch=Long term result of carotid endarterectomy for extracranial carotid artery stenosis

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Giang Đông Chung, Kim Quế Đỗ, Ngọc Quế Anh Đỗ

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.301-307

Bộ sưu tập: Metadata

ID: 243590

Thêm vào giỏ

Đánh giá kết quả dài hạn của phẫu thuật bóc lớp trong động mạch cảnh tại Bệnh viện Thống Nhất trong 20 năm với kinh nghiệm 1.600 trường hợp. Phương pháp nghiên cứu: Tiến cứu mô tả hàng loạt ca với toàn bộ 1.600 bệnh nhân được phẫu thuật bóc lớp trong động mạch cảnh tại Bệnh viện Thống Nhất trong thời gian 20 năm từ 2004 - 2024. Các đặc điểm về tuổi, giới tính, mức độ hẹp động mạch cảnh, tiền sử đột quỵ được ghi nhận qua hồ sơ bệnh án. Phẫu thuật bóc lớp trong động mạch cảnh được thực hiện dưới gây mê. Tiến hành bóc lớp trong động mạch cảnh qua đường mở dọc động mạch và phục hồi động mạch cảnh có miếng vá PTFE hoặc bóc lớp trong động mạch cảnh kiểu lộn ngược. Ghi nhận thời gian kẹp động mạch cảnh. Đánh giá tỉ lệ biến chứng, tử vong và đột quỵ não trong phẫu thuật, sau mổ 1 tháng, 1 năm, 5 năm, tỉ lệ hẹp tái phát động mạch cảnh sau phẫu thuật 1 năm và 5 năm. Kết quả: Tuổi trung bình là 72,5 (45 - 92), nam chiếm ưu thế với tỉ lệ nam:nữ là 2,4:1. Bệnh nhân hẹp động mạch cảnh không có triệu chứng chiếm 31,8% (508 trường hợp). Bệnh nhân có triệu chứng chiếm 68,2% với 1.092 trường hợp, trong đó 682 trường hợp (42,6 %) có đột quỵ não trước phẫu thuật và 410 bệnh nhân (25,6%) có biểu hiện cơn thiếu máu não thoáng qua. Hẹp cả 2 động mạch cảnh có ý nghĩa được phẫu thuật được ghi nhận ở 240 trường hợp chiếm tỉ lệ 15,0%. Bóc lớp trong kiểu lộn vỏ động mạch được thực hiện cho 435 trường hợp (27,2%)
bóc lớp trong động mạch theo phương pháp kinh điển áp dụng cho 1.161 trường hợp (72,6%)
phục hồi động mạch cảnh với miếng vá áp dụng cho 1.155 trường hợp (99,5%), khâu trực tiếp cho 6 trường hợp (0,5%)
cắt đoạn động mạch cảnh thay bằng ống mạch máu nhân tạo cho 4 trường hợp (0,25%). Thời gian kẹp động mạch cảnh trung bình là 23,9 phút. Có 5 bệnh nhân tử vong trong 1 tháng sau mổ chiếm tỉ lệ 0,3%
đột quỵ não trong mổ ở 8 trường hợp (0,5%), có 10 trường hợp (0,6%) đột quỵ trong thời gian 1 tháng sau phẫu thuật. Theo dõi sau phẫu thuật từ 1 tháng - 5 năm cho thấy tử vong sau 1 năm, 5 năm là 0,3% và 1,4%
đột quỵ não sau 1 năm và 5 năm là 0,1% và 0,9%
hẹp tái phát trên 50% tại thời điểm 1 năm và 5 năm sau phẫu thuật là 0,2 và 1,5%. Kết luận: Phẫu thuật bóc lớp trong động mạch cảnh là phương pháp điều trị hiệu quả và an toàn cho hẹp động mạch cảnh ngoài sọ, tỉ lệ đột quỵ và tử vong sau phẫu thuật thấp. Tỉ lệ tử vong, đột quỵ và tái hẹp sau 1 năm và 5 năm rất thấp.Review our experiences on carotid endarterectomy in Thongnhat hospital during 20 years with 1,600 cases. Methods: All of 1,600 CEA cases in our hospital during 20 year from 2004 to 2024 were prospectively ollected. Eveluate the clinical characteristics of stenosis of the carotid. Carotid endarterectomy was performed with conventional carotid endarterectomy in 1,161 cases (72.6%) and Eversion carotid endarterectomy in 435 cases (27.2%). Primary outcomes are death and stroke in 30 day, 1 year and 5 years after operation. Secondary outcomes are restenosis over 50% at 1 years and 5 years after operation. Results: The mean age was 72.5 range 45 to 92 year old, male:female was 2.4:1. Previous stroke in 682 patients (42.6%), TIA in 410 patients (25.6%) and asymptomatic in 508 patients (31.8%). Mean clamping time was 23.9 min. Perioperative mortality was 0.25% (5/1,600) with myocardial infarction being cause in 2 patients. Perioperative neurological morbidity was 0.6% (10/1,600) with 4 cases major and 6 minor strokes. In 16 cases (1.0%) had cervical hematoma, two cases need urgent operation for control bleeding. The recurrent laryngeal nerve involved in 10 cases (0.5%). The 1-year and 5-year mortality was 0.3% and 1.4%. Ipsilateral stroke after operation 30 days to 1-year and 5-year were 0.3% and 0.9%. The rates of restenosis >
50% at 1 year and 5 year are 0.2% and 1.5%. Conclusion: Carotid endarterectomy is effective and safety method for treatment extra-cranial carotid artery stensis. The low complication rate is related to improved preoperative patients evaluation, surgeons’ increasing experience and to surgical and anesthesiological techniques. The mortality, stroke and restenosis after operation 5 years are very low.

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