主动脉手术同期冠状动脉旁路移植术97例  

Clinical analysis of simultaneous aortic procedure with coronary artery bypass grafting

作　　者：白涛[1] 朱俊明[1] 郑军[1] 李建荣[1] 刘宁宁[1] 潘旭东[1] 刘永民[1] 孙立忠[1] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,100029

出　　处：《中华胸心血管外科杂志》2012年第7期418-420,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的总结行主动脉手术同期行冠状动脉旁路移植术的临床经验。方法回顾分析2009年1月至2011年12月，97例同期行主动脉手术和冠状动脉旁路移植术患者的临床资料。男88例，女9例；年龄（57．6±9．5）岁。其中，真性动脉瘤63例，主动脉夹层25例，主动脉狭窄及闭塞性病变7例，主动脉溃疡2例。诊断冠状动脉病变依靠术前冠状动脉造影、术前冠状动脉计算机体层摄影血管成像（CTA）检查和术中探查3种方式。术前确诊冠状动脉病变的比例分别为，真性动脉瘤组93．7％（59／63例），主动脉夹层组40．0％（10／25例），主动脉溃疡和狭窄闭塞组均为100．0％。结果术前未明确冠状动脉病变者行主动脉手术同期合并抢救性冠状动脉旁路移植术，术前明确冠状动脉病变的患者同期行常规冠状动脉移植术。两种情况各死亡3例。Fisher精确检验P=0．078，差异有统计学意义。结论对主动脉病变患者，术前尽可能常规行冠状动脉造影检查或冠状动脉CTA检查，主动脉手术同期合并常规冠状动脉旁路移植手术安全、可靠。Objective To summarized the experience of simultaneous aortic operation and coronary artery bypass graft （CABG）. Methods Ninety seven patients who underwent combined aortic operation and CABG were reviewed from January 2009 to December 2011. All patients are divided into four groups according to etiology, 63 aortic aneurysm, other 25 aortic dissection, 7 coarctation of aorta or occlusion of main branch , and the other two aortic ulcer. Mean age of all patients is（57.6 ± 9.5 ） years. The rate of preoperational diagnosis of coronary disease （ CAD ） were respectively 93.7% （ 59/63 ） , 40. 0% （10/25）, 100.0%, 100.0%. The patients made the preoperative diagnosis of CAD were performed selective simultaneous CABG with aortic procedures. The others without diagnosis of CAD had to receive urgent CABG during the aortic procedures. Results The aortic procedures with simultaneous urgent CABG had significant higher mortality than with selective CABG, 16.7% ,3.8% ,Fisher＇s exact test P =0. 078. Conclusion Selective simultaneous CABG with aortic procedures is safely. In aortic surgery, patients with risk factors of CAD should undergo preoperative coronary artery angiography or spiral computed tomography.

关 键 词：主动脉疾病 冠状动脉疾病 冠状动脉分流术 主动脉手术 

分 类 号：R654.2[医药卫生—外科学]