【正文】 ? HEPARIN NONREVERSAL ? POSTOPERATIVE CARE 第五十四頁，共六十一頁。 I. After the arteriotomy is closed, the ICA clip is briefly (1 sec) opened. II. The clips are then removed from the ECA, the superior thyroid artery and the CCA. III. The last to remove is the clip from the ICA. IV. Direct dopplerometry is used to check the patency and disclose any irregularities in the vessels。 頸外動脈斑塊處理： Atheromatous core extends into the external carotid artery, usually for 5–10 mm. Y型切開： 第四十五頁，共六十一頁。 Dissector〔剝離子的使用〕 The inner is a thickened, irregular longitudinal length of atheroma with the intima that may be ulcerated and covered with thrombus. The outer layer is yellow and uniform in thickness: it is a layer of thickened intimomedial fibers that may peel off easily as a circular strip, but which can also be left in situif firmly adherent to the wall. 第四十一頁，共六十一頁。 頸袢： Ansa cervicalis。 需耐心處理的：淋巴結(jié) 需注意的：觀察心率，必要時應(yīng)用局麻藥物；不要急于升壓提升心率 Posterior belly of the digastric muscle。 第三十二頁，共六十一頁。 粥樣斑塊〔粥糜樣物〕 狹窄處的真腔縫隙 狹窄真腔 第二十五頁，共六十一頁。 顯微操作中器械 第二十二頁，共六十一頁。 ? 腦血流峰值、平均值、收縮期、舒張期 第十五頁，共六十一頁。 Conclusion: The two groups did not significantly differ for quality of life, length of hospital stay, or the primary oute in the prespecified subgroups of age, contralateral carotid occlusion, and baseline surgical risk. 兩個組在生活質(zhì)量、住院時間、預設(shè)不同年齡組的結(jié)果、雙側(cè)頸動脈閉塞和手術(shù)風險等方面均無顯著差異。 III. Head is placed on a ring, with a sandbag under the shoulders。 國家遠程卒中中心、腦防委 CEA培訓基地、北京市腦血管病中心 第二頁，共六十一頁。 手術(shù)切口 第六頁，共六十一頁。 麻醉深度監(jiān)測 麻醉深度電極 腦氧監(jiān)測 第十一頁，共六十一頁。 操作流程 ? 別離暴露動脈鞘 ? 顯微操作階段：切開剝離斑塊、縫合動脈 ? 關(guān)閉動脈鞘、分層縫合。 ? 器械對縫合線的損傷隱患最大。 Standard CEA technique. P Plaque, T superior thyroid artery, L longitudinal arteriotomy CEA technique with intraluminal shunt. IS Intraluminal shunt, R rubber band around the CCA, C window aneurysm clip at the ICA, P plaque, T superior thyroid artery 第二十八頁，共六十一頁。 Arteria branch of the great auricular nerve。 頸袢： Ansa cervicalis。 especially at the bifurcation it runs some 3 mm lateral from the upper aspect of the bifurcation。 第四十二頁，共六十一頁。 Residual clot is flushed away. 第四十七頁，共六十一頁。 Covered by a small strip of oxycellulose。 術(shù)中解剖演示 第五十七頁，共六十一頁