分析复合手术治疗慢性颈内动脉闭塞的疗效及优越性。

回顾性收集深圳市第二人民医院神经外科血管病区自2020年1月至2022年9月采用复合手术（颈动脉内膜切除联合介入球囊扩张）治疗的20例慢性颈内动脉闭塞患者的临床资料，分析其使用复合手术治疗后血管再通情况和预后，采用配对样本t检验来比较闭塞侧颈内动脉远端血管术前和术后直径的差异，判断复合手术治疗是否有助于恢复颈内动脉远端血管的直径，以达到增加脑组织灌注的目的。

应用复合手术治疗病例20例，术后颈内动脉即刻再通病例19例，再通失败1例，无脑梗死、脑出血或神经功能障碍等并发症出现；统计分析结果：闭塞侧颈内动脉远端治疗前血管直径为（1.35±0.13）mm，复合手术治疗后血管直径为（2.41±0.11）mm，手术治疗前后血管直径的差值为（1.06±0.08）mm，差值的95%可信区间为1.02~1.10 mm，手术治疗后血管直径宽于治疗前，差异具有统计学意义（t=58.160，P＜0001）。随访时间为1年，18例成功再通患者返院复查脑血管CT，检查结果均提示血管再通良好，1例成功再通患者复查脑血管CT提示手术侧血管重度狭窄，期间进行了二次介入支架植入术，成功再通患者随访期间均无脑出血或脑梗死等并发症出现，精神状态及认知功能较术前明显改善；1例再通失败患者随访期间精神运动等情况良好，无相关并发症出现。

复合手术对闭塞血管再通疗效显著，能有效地解决单一手术的局限性，并提高了手术的成功率，降低了手术相关并发症。

To preliminarily study the efficacy and superiority of hybrid surgery in the treatment of chronic internal carotid artery occlusion.

The clinical data of 20 patients with chronic internal carotid artery occlusion treated with hybrid surgery (carotid intima stripped combined interventional balloon expansion) in the Department of Neurosurgery, Shenzhen second People's Hospital from January 2020 to September 2022 were retrospectively collected. The recanalization and prognosis of the patients after hybrid surgery were analyzed. Paired sample t test was used to compare the preoperative and postoperative diameters of the distal vessels of the occlusive internal carotid artery, and to determine whether the hybrid surgical treatment can help restore the diameter of the distal vessels of the internal carotid artery, so as to increase the cerebral tissue perfusion.

Twenty cases were treated by hybrid operation. Among them, 19 cases had immediate recanalization of internal carotid artery after operation, and another case had recanalization failure. No complications, such as cerebral infarction, cerebral hemorrhage, or neurological dysfunction, occurred. Statistical analysis results showed at the distal end of the occlusive internal carotid artery, the mean baseline vascular diameter was (1.35±0.13)mm before treatment and (2.41±0.11)mm after the hybrid operation. The difference of vascular diameter before and after the operation was (1.06±0.08)mm, 95%CI of the difference: 1.02-1.10. the average level of vascular diameter after surgical treatment was higher than that before treatment, and the difference was statistically significant (t=58.160, P＜0001). As for 1-year follow-up, 18 patients with successful cases returned to the court review of cerebral CT examination suggests that recanalization was good; Another one case of successful cases of patients with review of cerebral CT in vascular surgery side severe stricture, during the second step in stent implantation, successful cases during the follow-up of patients with no complications such as cerebral hemorrhage or cerebral infarction. The mental state and cognitive function were significantly improved. One patient with recanalization failure had good psychological and movement condition and other conditions during the follow-up, and no related complications occurred.

Hybrid operation of recanalization occluded has clear curative effect and the recovery of distal vascular blood flow was statistically significant, Hybrid surgery can effectively solve the limitations of single operation and improves the success rate of surgery and reduce the complications related to the operation.