激光心肌血管重建加冠状动脉旁路术在冠心病治疗中的应用  

Clinical application of combined TMLR with CABG to treat coronary artery disease

作　　者：万峰[1] 江龙[1] 杨碧波[1] 芮志良[1] 刘晓飞 王升声[1] 高峰[1] 

机构地区：[1]邮电总医院心脏外科

出　　处：《中华心血管病杂志》1998年第6期429-431,共3页Chinese Journal of Cardiology

摘　　要：目的回顾应用激光心肌血管重建术（ｔｒａｎｓｍｙｏｃａｒｄｉａｌｌａｓｅｒｒｅｖａｓｃｕｌａｒｉｚａｔｉｏｎ，ＴＭＬＲ）加冠状动脉旁路术（ｃｏｒｏｎａｒｙａｒｔｅｒｙｂｙｐａｓｇｒａｆｔｉｎｇ，ＣＡＢＧ）联合手术治疗冠心病的早期效果和经验。方法５０例病人皆为冠心病冠状动脉造影三支病变（男性４３例，女性７例），平均年龄５５岁（３６～７４岁），其中１５例左室射血分数小于３０％，８０％病人的心绞痛ＣＣＳ分级为Ⅲ～Ⅳ级。４例行左前外小切口非体外循环跳动心脏手术，其它为常规正中开胸低温体外循环下行ＣＡＢＧ＋ＴＭＬＲ术，９０％的病人使用了乳内动脉。术后１４例病人需要主动脉球囊反搏（ＩＡＢＰ）辅助循环。ＴＭＬＲ使用钬激光机（美国ＥｃｌｉｐｓｅＴＭＲＳｙｓｔｅｍ２０００型，２０Ｗ）。平均每例搭桥３．８根，激光打孔３５个。结果一年中完成５０例手术，获得了良好的临床效果，无一例死亡，术后不仅明显缓解心绞痛症状，而且能改善了心功能。结论本组病人近期良好的临床效果表明，ＣＡＢＧ＋ＴＭＬＲ是一种安全、有效的治疗冠心病的方法，特别适用于重症、弥漫。Objective To retrospectively review the experience and the early clinical results of a new surgical technique for the treatment of coronary artery disease(CAD). Methods From July of 1996 to July of 1997, we have performed combined coronary artery bypass grafting (CABG) with transmyocardial laser revascularization (TMLR) on 50 patients (male 43, female 7 )with tri vessel diseae,aged from 36 74 years with a mean of 55. Left ventricular ejection fraction of 15 patients were lower than 30%. Eighty percent patients had class III or IV preoperative angina. Four patients were operated upon a beating heart with mini left anterior thoracotomy without CPB (Cardiopulmonary bypass). For TMLR the holium YAG laser machine (20W) was used. The mean number of grafts was 3.8, the average number of laser created channels was 35. Internal mammary artery (IMA) was used in 90% of patients. Post operative intraaortic balloon pump (1ABP) support was required in 14 cases. Results Postoperative mortality was 0/50, all patients were still alive at a mean follow up period of 6 months with 17 being angina free and 19 in class I angina. Conclusion The good short term results indicate that the combined CABG with TMLR is surgically feasible, effective and safe, especially for severe patients with diffused CAD.

关 键 词：冠心病 TMLR 冠状动脉旁路术 

分 类 号：R654.2[医药卫生—外科学]