頸動脈不全症に対する手術治療成績

RESULT OF SURGICAL TREATMENT OF CAROTID ARTERY INSUFFICIENCY

1．緒言

　頸動脈不全症は頭蓋外頸勤脈の狭窄または閉塞を示す疾患の総称で，直接脳血流量減少をきたすかあるいは病変部より壁在性血栓の流出を生じ，またはコレステロール栓子を流出させ，あるいは脳血管攣縮を生じて脳の一部に乏血を生じ一過性，進行性または永続性の脳機能障害を発生する。原因疾患は動脈硬化症がもつとも多く，これに外傷，動脈炎，膠原病，奇形などがあり，さらに騎乗塞栓を分岐部に生ずる塞栓症がある。

　Rob^1）によれば典型的脳卒中の約25％は頸動脈疾患に起因するという。頸動脈狭窄疾患はすでに1665年Wnlisにより初めて記載されたというが，今世紀初期に到りChiari^2），Hunt^3）らの頸動脈病理と臨床症状を結びつけるための努力により注目されだした，Monizの頸動脈撮影術の発明は本症の生前診断を可能にした。また1942年のHultquist^4）の1,400剖検例に基づく頸動脈硬化症に対する観察は本疾患の現代病理知識の墓礎を確立した。

Out of a total of 64 carotid insufficiency cases statistical observations were made on 33 patients who bad had carotid operations.

(1) Best operative results with functional im-provements were seen in the patient episodes of symptomatology ; worst results were seen in the patients with complete type of stroke. It must be emphasized that early diagnosis and early treatment is most important to obtain better operative results. (2) The operative results in the patients with stenotic carotid artery were better than in the pa-tients with obstructive one.

(3) Postoperative angiographic re-examination is an important follow up as clinical improvement might overshadow dangerous possibility of insidious postoperative obstruction.

(4) The rate of postoperative patent carotid artery was improved by means of either patch method or postoperative use of anticoagulants, or both of them.

(5) The significances of recontructive carotid operation in the patients with transient episodes are discussed as are also the indication and the timing problem of operation on completely obstructed carotid artery and bilaterally obstructed one.