同期冠状动脉旁路移植联合颈动脉内膜切除术治疗冠状动脉并存颈动脉重度狭窄的临床观察  

Clinical observation of simultaneous coronary artery bypass grafting and carotid endarterectomy for thetreatment of combined coronary and carotid artery severe stenosis

作　　者：钱松屹[1] 刘鹏[1] 叶志东[1] 任师颜[1] 王非[1] 林凡[1] 杨煜光[1] 樊雪强[1] 甄雅楠[1] 王凤林[1] 

机构地区：[1]中日友好医院心脏血管外科,北京100029

出　　处：《中华老年医学杂志》2013年第6期586-588,共3页Chinese Journal of Geriatrics

摘　　要：目的探讨同期冠状动脉旁路移植术（CABG）联合颈动脉内膜切除术（CEA）治疗冠状动脉重度狭窄合并颈动脉重度狭窄的安全性和临床疗效。方法总结2001年1月至2012年9月我科施行的CABG和CEA同期手术31例患者的临床资料，其中男19例、女12例，年龄54～80岁，平均（67±12）岁。患者术前经选择性冠状动脉和双侧颈动脉造影明确诊断，其中冠状动脉左主干病变6例，3支血管病变15例，2支血管病变10例。术式先行CEA再行CABG者30例，1例患者先行CABG再行CEA。CABG于非体外循环下施行者24例，7例于体外循环下施行。CEA全部为单侧，术中均使用颈动脉转流管，并采用人工血管补片成形颈动脉切口。结果本组无手术死亡病例，无围术期心肌梗死、脑血管意外。1例患者于术后1个月因下肢动脉硬化闭塞症行右侧股一胭动脉人工血管旁路移植。术后随访6～84个月，本组中无心脑血管事件发生。结论CABG联合CEA处理冠状动脉合并颈动脉重度狭窄安全、有效，可有效预防围术期心脑血管并发症发生，中期随访效果满意。Objective To evaluate clinical safety and efficacy of simultaneous coronary artery bypass grafting （CABG） and carotid endarterectomy （CEA） in patients with combined coronary and carotid artery severe stenosis. Methods From January 2000 to September 2012, 31 patients [19 males, 12 females, aged （67± 12） years in average] underwent combined CABG and CEA in our hospital. Preoperative coronary and carotid artery angiography revealed that left main trunk stenosis occurred in 6 cases, triple-vessel disease in 15 cases, double-vessel disease in 10 cases. 30 patients were given unilateral CEA firstly and then CABG. Only 1 case was given CABG firstly and then unilateral CEA. 24 cases underwent CABG without cardiopulmonary bypass （CPB）, and 7 cases underwent CABG with CPB. An intraluminal coronary shunt tube and patch repair were used in CEA procedure. Results There were no operative mortality and perioperative cardio-cerebra[ vascular accidents in this study. 1 case received right femo-popliteal artificial graft bypass for lower extremity atherosclerotic occlusive disease 1 month after the simultaneous CABG and CEA. No cardiovascular events were observed during the 6 84-month follows-up period. Conclusions The simultaneous CABG and CEA is an effective and safe treatment for combined coronary and carotid artery severe stenosis. It can effectively prevent postoperative cardio-eerebral vascular complications with satisfactory mid term follow-up result.

关 键 词：冠状动脉旁路移植术 颈动脉内膜切除术 围术期并发症 

分 类 号：R65[医药卫生—外科学]