颈动脉内膜剥脱术后颈部神经损伤的危险因素分析

doi:10.3760/cma.j.cn101202-20200522-00168

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摘要目的探讨颈动脉内膜剥脱术(CEA)后颈部神经损伤(CNI)的相关危险因素。方法采用回顾性研究方法。纳入天坛医院2012年4月—2015年5月209例CEA患者的临床资料,其中男177(84.69%)例、女32(15.31%)例,年龄42~80(67.5±8.8)岁。(1)统计患者术后CNI的发生率及临床表现。(2)纳入性别、年龄、有无糖尿病等影响因素,做CNI的单因素和多因素logistic回归模型分析;采用比值比(OR)及95%可信区间(CI)进行风险评估。结果 (1)209例患者术后有16例发生CNI,发生率7.66%。其中迷走神经损伤的患者最多,为9例(4.3%),表现为术后声音嘶哑;其次为舌下神经损伤3例(1.44%),症状较轻。出院时CNI临床症状基本消失。(2)单因素分析显示,糖尿病[OR(95% CI)为2.782(0.990～7.819),P＜0.05]、年龄70～80岁[OR(95% CI)为3.58(1.268～10.111),P＜0.05]、女性[OR(95% CI)为3.854(1.292～11.499),P＜0.05]是影响CNI发生的相关因素。多因素回归分析显示,糖尿病[OR(95% CI)为3.594(1.188～10.878),P＜0.05]、年龄70～80岁[OR(95% CI)为5.024(1.625～15.528),P＜0.01]、女性[OR(95% CI)为5.353(1.615～17.737),P＜0.01]是CNI的独立危险因素。结论糖尿病、年龄70～80岁、女性是 CEA术后CNI的独立危险因素。因此,对于高龄女性糖尿病CEA患者围术期需给予更多关注。

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	肖特
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	刘珊珊

关键词 ：颈动脉内膜切除术, 颈部神经损伤, 危险因素, 糖尿病

Abstract：Objective To investigate the risk factors of cervical nerve injury (CNI) after carotid endarterectomy (CEA). Methods We retrospectively analyzed 209 cases of CEA in Tiantan Hospital from April 2012 to May 2015, including 177 males (84.69%) and 32 females (15.31%) aged 42-80(67.5±8.75) years old. (1) Postoperative CNI was statistically analyzed. (2) Univariate and multivariate logistic regression analyses were performed to determine the risk factors of CNI, including gender, age, and diabetes. Risk factors for CNI were assessed by odds ratios(OR) and 95% confidence intervals(CI). Results Sixteen cases developed CNI after surgery. The incidence was 7.66%. The main symptom was vagus nerve injury (9 cases, 4.3%), which was manifested as hoarseness after surgery, followed by hypoglossal nerve injury (3 cases, 1.44%), which was manifested by mild symptoms and disappeared upon discharge from the hospital. (2) Univariate analysis showed that diabetes mellitus (OR[95% CI]: 2.782 [0.990-7.819], P＜0.05), age 70-80 years (OR[95% CI]: 3.58 [1.268-10.111], P＜0.05), and female gender (OR[95% CI]: 3.854 [1.292-11.499], P＜0.05) were related factors affecting the occurrence of CNI. Multivariate regression analysis showed that diabetes mellitus (OR[95% CI] 3.594 [1.188-10.878], P＜0.01), age 70-80 years (OR[95% CI]: 5.024 [1.625-15.528], P＜0.01), and female gender (OR[95% CI]: 5.353 [1.615-17.737], P＜0.01) were independent risk factors for CNI. Conclusions Diabetes, age 70-80 years, and female gender are independent risk factors for CNI after CEA surgery. Therefore, more attention should be paid to elderly female diabetic patients with CEA.

Key words： Endarterectomy, carotid Cervical nerve injury Risk factors Diabetes mellitus

收稿日期: 2020-05-22

通讯作者: 张东,Email:zhangdong0660@aliyun.com

引用本文:

肖特, 张东, 喻乐宝, 刘珊珊. 颈动脉内膜剥脱术后颈部神经损伤的危险因素分析[J]. 中华解剖与临床杂志, 2021, 26(2): 193-196.
Xiao Te, Zhang Dong, Yu Lebao, Liu Shanshan. Analysis of the risk factors of cervical nerve injury after carotid endarterectomy. Chinese Journal of Anatomy and Clinics, 2021, 26(2): 193-196.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20200522-00168 或 http://www.cjac.com.cn/CN/Y2021/V26/I2/193

[1]	Maroulis J, Karkanevatos A, Papakostas K, et al. Cranial nerve dysfunction following carotid endarterectomy[J]. Int Angiol, 2000, 19(3): 237-241.
[2]	Ballotta E, Da Giau G, Renon L, et al. Cranial and cervical nerve injuries after carotid endarterectomy: a prospective study[J]. Surgery, 1999, 125(1): 85-91.
[3]	Avgerinos ED, Kakisis JD, Moulakakis KG, et al. Statins influence long term restenosis and cardiovascular events following carotid endarterectomy[J]. Curr Vasc Pharmacol, 2015, 13(2): 239-247. DOI:10.2174/15701611113119990130.
[4]	Cheng SW, Ting AC, Wu LL.Ultrasonic analysis of plaque characteristics and intimal-medial thickness in radiation-induced atherosclerotic carotid arteries[J]. Eur J Vasc Endovasc Surg, 2002, 24(6): 499-504. DOI:10.1053/ejvs.2002.1752.
[5]	AbuRahma AF, Choueiri MA.Cranial and cervical nerve injuries after repeat carotid endarterectomy[J]. J Vasc Surg, 2000, 32(4): 649-654. DOI:10.1067/mva.2000.109751.
[6]	Zannetti S, Parente B, De Rango P, et al. Role of surgical techniques and operative findings in cranial and cervical nerve injuries during carotid endarterectomy[J]. Eur J Vasc Endovasc Surg, 1998, 15(6): 528-531. DOI:10.1016/s1078-5884(98)80114-7.
[7]	Bennett KM, Scarborough JE, Shortell CK.Risk factors for cranial nerve injury after carotid endarterectomy[J]. J Vasc Surg, 2015, 62(2): 363-368. DOI:10.1016/j.jvs.2015.02.047.
[8]	Fokkema M, de Borst GJ, Nolan BW, et al. Clinical relevance of cranial nerve injury following carotid endarterectomy[J]. Eur J Vasc Endovasc Surg, 2014, 47(1): 2-7. DOI:10.1016/j.ejvs.2013.09.022.
[9]	洪韬, 宋刚, 谌燕飞, 等. 颈动脉内膜切除术后脑神经损伤的分析[J]. 中国脑血管病杂志, 2014, 11(8): 411-414. DOI:10.3969/j.issn.1672-5921.2014.08.005.Hong T, Song G, Chen YF, et al. Analysis of cranial nerve injury after carotid endarterectomy[J]. Chin J Cerebrovasc Dis, 2014, 11(8): 411-414. DOI:10.3969/j.issn.1672-5921.2014.08.005.
[10]	Chiu B, Viira E, Tucker W, et al. Chlamydia pneumoniae, cytomegalovirus, and herpes simplex virus in atherosclerosis of the carotid artery[J]. Circulation, 1997, 96(7): 2144-2148. DOI:10.1161/01.cir.96.7.2144.
[11]	Lovett JK, Gallagher PJ, Hands LJ, et al. Histological correlates of carotid plaque surface morphology on lumen contrast imaging[J]. Circulation, 2004, 110(15): 2190-2197. DOI:10.1161/01.CIR.0000144307.82502.32.
[12]	Brott TG, Hobson RW 2nd, Howard G, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis[J]. N Engl J Med, 2010, 363(1): 11-23. DOI:10.1056/NEJMoa0912321.
[13]	Cunningham EJ, Bond R, Mayberg MR, et al. Risk of persistent cranial nerve injury after carotid endarterectomy[J]. J Neurosurg, 2004, 101(3): 445-448. DOI:10.3171/jns.2004.101.3.0445.
[14]	Ferguson GG, Eliasziw M, Barr HW, et al. The North American Symptomatic Carotid Endarterectomy Trial : surgical results in 1415 patients[J]. Stroke, 1999, 30(9): 1751-1758. DOI:10.1161/01.str.30.9.1751.
[15]	Greenstein AJ, Chassin MR, Wang J, et al. Association between minor and major surgical complications after carotid endarterectomy: results of the New York Carotid Artery Surgery study[J]. J Vasc Surg, 2007, 46(6): 1138-1144; discussion 1145-1146. DOI:10.1016/j.jvs.2007.08.026.
[16]	Forssell C, Kitzing P, Bergqvist D.Cranial nerve injuries after carotid artery surgery.A prospective study of 663 operations[J]. Eur J Vasc Endovasc Surg, 1995, 10(4): 445-449. DOI:10.1016/s1078-5884(05)80167-4.
[17]	Thirumala PD, Kumar H, Bertolet M, et al. Risk factors for cranial nerve deficits during carotid endarterectomy: a retrospective study[J]. Clin Neurol Neurosurg, 2015, 130: 150-154. DOI:10.1016/j.clineuro.2014.12.017.
[18]	Hye RJ, Mackey A, Hill MD, et al. Incidence, outcomes, and effect on quality of life of cranial nerve injury in the Carotid Revascularization Endarterectomy versus Stenting Trial[J]. J Vasc Surg, 2015, 61(5): 1208-1214. DOI:10.1016/j.jvs.2014.12.039.