颈动脉内膜切除术.ppt

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1、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

2、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

3、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.

4、 of Vasc Surg.,-Eversionpatch,Changhai Hospital, Shanghai,standardCEA, sCEA eversionCEA, eCEA patchCEA, pCEA graftCEA, gCEA,Carotid Endarterectomy(CEA),standardCEA,sCEA,eversionCEA,eCEA,Carotid Endarterectomy(CEA),patchCEA,pCEA,graftCEA,gCEA,Carotid Endarterectomy(CEA),Eversion & patch,CEA METHOD,In

5、dication Special indication Shunt Block time Patency rate,Local beginning ICA Thin internal carotid Superfluous twist ICA Myofibrodysplasia unused used short long high high,close to common carotid bifurcation Lower carotid bifurcation Local stenosis,Eversion Carotid Endarterectomy(eCEA),Indication,I

6、CA angulation,Eversion Carotid Endarterectomy(eCEA),Indication,Superfluous twist ICA,Long stenosis of ICA High bifurcation Restenosis of CEA,Eversion Carotid Endarterectomy(eCEA),Contra-indication,Eversion Carotid Endarterectomy(eCEA),Technique point,Common complication,nerve injury Endangium tear，d

7、issection Postoperation hypertension hoarse voice hematoma stroke,Eversion Carotid Endarterectomy(eCEA),Indication,Diameter of ICA3mm,Thin oncoides Restenosis after CEA Myofibrodysplasia,Carotid Endarterectomy(CEA) with path,Autovenous path Saphenous vein Preoperative design,Path Material,Artificial

8、 Material PTFE Dacron Pericardium,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(CE

9、A) with patch,Common complication,Aneurysm，pseudoaneurysm Endangium tear，dissection Postoperation hypertension hematoma stroke,Anaesth,Position,Monitor,Example operation,Exposure,Block,Discission,Eversion CEA,Example operation,Bathe,Eversion,Discission,Example operation,Eversion CEA,Anastomosis,Drai

10、n,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,Case Shunt Block time Patency rate Complication,200+ 20+ unuse 5 cases 13min 22min high high A few A few,Our result,Carotid Endarterectomy(CEA),THANKS,