颈动脉内膜切除术.ppt
颈动脉内膜切除术,赵 志 青,上海长海医院血管外科,外翻术式&补片术式,颈动脉内膜切除术的方式,标准术式外翻术式增加补片间置血管,标准术式,翻转术式,颈动脉内膜切除术的方式,补片术式,间断移植物术式,颈动脉内膜切除术的方式,外翻术式&补片术式,颈动脉内膜切除术的方式,适应症特殊指征转流管阻断时间通畅率,颈内起始局限 颈内动脉纤细颈内动脉扭曲 肌纤维发育不良不用 用短 长高 高,适应症,在颈总动脉分叉部附近颈总动脉分叉位置较低范围局限,外翻式颈动脉内膜切除术,适应症,外翻式颈动脉内膜切除术,颈内动脉扭曲,颈内动脉成角,禁忌症,颈内动脉长段狭窄颈动脉分叉高CEA后再狭窄,外翻式颈动脉内膜切除术,技术要点,外翻式颈动脉内膜切除术,常见并发症,外翻式颈动脉内膜切除术,神经损伤血管内膜撕裂,夹层形成术后高血压声音嘶哑血肿形成术中及术后卒中,使用补片的颈动脉内膜切除术,适应症,颈内动脉口径3mm,膨大部较小CEA术后再狭窄肌纤维发育不良,使用补片的颈动脉内膜切除术,人工材料PTFE补片涤纶补片牛心包补片,自体静脉补片大隐静脉首选术前计划,补片材料,补片长度 56cm,补片宽度 56mm,使用补片的颈动脉内膜切除术,技术要点,缝合起点 颈内动脉,切口长度 超过分叉,使用补片的颈动脉内膜切除术,技术要点,使用补片的颈动脉内膜切除术,常见并发症,动脉瘤，假性动脉瘤血管内膜撕裂,夹层形成术后高血压血肿形成术中及术后卒中,麻 醉,体 位,监 护,手术实例,手术实例,暴 露,阻 断,切 开,外翻术式,手术实例,冲洗,外翻,切 开,外翻术式,手术实例,外翻术式,外翻术式,外翻术式,手术实例,手术实例,补片术式,手术实例,补片术式,手术实例,补片术式,补片术式,手术误区,外翻术式,外翻术式&补片术式,颈动脉内膜切除术,例数转流管阻断时间通畅率并发症,200+20+不用 5例13分钟 22 高 高少 少,我们的结果,谢谢,Carotid Endarterectomy(CEA),ZHAO Zhiqing,Dept.of Vasc Surg.,-Eversionpatch,Changhai Hospital,Shanghai,standardCEA,sCEAeversionCEA,eCEApatchCEA,pCEAgraftCEA,gCEA,Carotid Endarterectomy(CEA),standardCEA,sCEA,eversionCEA,eCEA,Carotid Endarterectomy(CEA),patchCEA,pCEA,graftCEA,gCEA,Carotid Endarterectomy(CEA),Eversion&patch,CEA METHOD,Indication Special indicationShuntBlock time Patency rate,Local beginning ICA Thin internal carotid Superfluous twist ICA Myofibrodysplasia unused used short long high high,close to common carotid bifurcationLower carotid bifurcationLocal stenosis,Eversion Carotid Endarterectomy(eCEA),Indication,ICA angulation,Eversion Carotid Endarterectomy(eCEA),Indication,Superfluous twist ICA,Long stenosis of ICAHigh bifurcationRestenosis of CEA,Eversion Carotid Endarterectomy(eCEA),Contra-indication,Eversion Carotid Endarterectomy(eCEA),Technique point,Common complication,nerve injuryEndangium tear，dissectionPostoperation hypertensionhoarse voicehematomastroke,Eversion Carotid Endarterectomy(eCEA),Indication,Diameter of ICA3mm,Thin oncoidesRestenosis after CEAMyofibrodysplasia,Carotid Endarterectomy(CEA)with path,Autovenous pathSaphenous veinPreoperative design,Path Material,Artificial MaterialPTFEDacronPericardium,Carotid Endarterectomy(CEA)with path,Carotid Endarterectomy(CEA)with patch,Length of patch 56cm,Width of patch 56mm,Technique point,Carotid Endarterectomy(CEA)with patch,Incision Length Over bifurcation,starting point ICA,Technique point,Carotid Endarterectomy(CEA)with patch,Common complication,Aneurysm，pseudoaneurysmEndangium tear，dissectionPostoperation hypertensionhematomastroke,Anaesth,Position,Monitor,Example operation,Exposure,Block,Discission,Eversion CEA,Example operation,Bathe,Eversion,Discission,Example operation,Eversion CEA,Anastomosis,Drain,Open,Example operation,Eversion CEA,Example operation,Eversion CEA,Example operation,CEA with patch,Example operation,CEA with patch,CEA with patch,Example operation,pCEA,Incorrect technique,eCEA,eCEA&pCEA,CaseShuntBlock timePatency rateComplication,200+20+unuse 5 cases13min 22minhigh highA few A few,Our result,Carotid Endarterectomy(CEA),THANKS,
