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,CarotidEndarterectomy(CEA),ZHAOZhiqing,Dept.ofVascSurg.,-Eversionpatch,ChanghaiHospital,Shanghai,standardCEA,sCEAeversionCEA,eCEApatchCEA,pCEAgraftCEA,gCEA,CarotidEndarterectomy(CEA),standardCEA,sCEA,eversionCEA,eCEA,CarotidEndarterectomy(CEA),patchCEA,pCEA,graftCEA,gCEA,CarotidEndarterectomy(CEA),Eversion&patch,CEAMETHOD,IndicationSpecialindicationShuntBlocktimePatencyrate,LocalbeginningICAThininternalcarotidSuperfluoustwistICAMyofibrodysplasiaunusedusedshortlonghighhigh,closetocommoncarotidbifurcationLowercarotidbifurcationLocalstenosis,EversionCarotidEndarterectomy(eCEA),Indication,ICAangulation,EversionCarotidEndarterectomy(eCEA),Indication,SuperfluoustwistICA,LongstenosisofICAHighbifurcationRestenosisofCEA,EversionCarotidEndarterectomy(eCEA),Contra-indication,EversionCarotidEndarterectomy(eCEA),Techniquepoint,Commoncomplication,nerveinjuryEndangiumtear，dissectionPostoperationhypertensionhoarsevoicehematomastroke,EversionCarotidEndarterectomy(eCEA),Indication,DiameterofICA3mm,ThinoncoidesRestenosisafterCEAMyofibrodysplasia,CarotidEndarterectomy(CEA)withpath,AutovenouspathSaphenousveinPreoperativedesign,PathMaterial,ArtificialMaterialPTFEDacronPericardium,CarotidEndarterectomy(CEA)withpath,CarotidEndarterectomy(CEA)withpatch,Lengthofpatch56cm,Widthofpatch56mm,Techniquepoint,CarotidEndarterectomy(CEA)withpatch,IncisionLengthOverbifurcation,startingpointICA,Techniquepoint,CarotidEndarterectomy(CEA)withpatch,Commoncomplication,Aneurysm，pseudoaneurysmEndangiumtear，dissectionPostoperationhypertensionhematomastroke,Anaesth,Position,Monitor,Exampleoperation,Exposure,Block,Discission,EversionCEA,Exampleoperation,Bathe,Eversion,Discission,Exampleoperation,EversionCEA,Anastomosis,Drain,Open,Exampleoperation,EversionCEA,Exampleoperation,EversionCEA,Exampleoperation,CEAwithpatch,Exampleoperation,CEAwithpatch,CEAwithpatch,Exampleoperation,pCEA,Incorrecttechnique,eCEA,e