頸動脈内膜切除術後の創部出血 : 自験例の検討と対策

概要

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In recent large randomized trials performed in North America and Europe, the beneficial effects and guidelines of carotid endarterectomy (CEA) have been reconfirmed for symptomatic and asymptomatic patients with high-grade carotid artery stenosis. These studies also demonstrate that successful results of CEA dependen upon surgeons having minimum perioperative morbidity and mortality rates. Wound hematoma is the most basic technical complication, and the incidence rates in the literature ranges from 1.9 to 4.3%. Especially, arterial bleeding from the suture line or the disrupted wall is fatal, and higher occurrence has been reported in the case of inexperienced surgeons. Each process of CEA, including arterial preparation, removal of atheroma plaque and suture of arteriotomy requires the ability to perform surgical procedures with minimum complications. Meticulous surgical technique in obtaining hemostasis and control of postoperative hypertension will help reduce the incidence of postoperative wound hematoma. Based on our clinical experiences of 215 cases, we present our ideas and technique of CEA to prevent wound hematoma. We also review the recent clinical data and discuss the existing state and problems of this clinical category of CEA in Japan.
2001-05-31