| 摘要: |
| 颈动脉内膜切除术（CEA）是治疗颈动脉狭窄、预防脑卒中的“金标准”，国外已相对成熟，国内虽起步晚，但发展迅速。笔者在CEA的推广过程中，发现很多同道虽然可基本掌握手术技巧，但在概念理解、术式选择、技术理念、并发症防治等方面与国际先进水平仍存差距。很多同道在实际工作中仍在纠结于以下问题：CEA是切斑块还是切内膜?如何切除?切除的部位?切除到何种程度?是否需加做血管裁剪和吻合口成形?本文针对CEA在“真实世界”中的四则争议——概念存疑、术式纠结、理念差异和技术困惑——进行概括并提出个人思考，同时与各位读者分享本领域的最新进展。 |
| 关键词: 斑块切除术 颈动脉内膜切除术 颈动脉狭窄 卒中 |
| DOI：10.16781/j.0258-879x.2017.01.0001 |
| 投稿时间：2016-10-14修订日期：2016-10-17 |
| 基金项目:上海高校特聘教授（东方学者）跟踪计划基金（GZ2016008），上海领军人才基金（035），国家自然科学基金（81570440），上海市科委2016年度医学引导类（中、西医）科技支撑项目基金（16411966500）. |
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| Carotid endarterectomy in the real world: controversies and thinkings |
| QU Le-feng*,BAI Jun,WU Jian-jin |
(Department of Vascular and Endovascular Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
*Corresponding author) |
| Abstract: |
| As the "gold standard" treatment for carotid artery stenosis to prevent ischemic stroke, carotid endarterectomy (CEA) has been widely accepted in the western countries; but was developing rapidly only within the past years in China. We noticed that many surgeons in China can master the surgical skills, but there is still much room for improvement in their concept understanding, surgical procedure selections, technical concepts, complication management and other aspects. Many surgeons are still puzzled by the following questions during their clinical practices, such as "Is it the plaque or intima that should be resected in CEA?" "How to resect?" "How to select the resecting site?" "To what extent should it be resected?", and "Whether to perform additional vascular cutting and anastomotic plasty?". Hereby, we summarize the above four controversies of CEA in the real world, including concept doubt, surgical tangle, conceptual differences and technical confusion. We also put forward our thinkings on the issues and shared the latest developments in this field. |
| Key words: atherectomy carotid endarterectomy carotid stenosis stroke |
