序贯旁路移植同期行内膜剥脱在非体外循环冠脉搭桥术中的应用  

Clinical application of concomitant sequential off-pump coronary artery bypass and coronary endarterectomy

作　　者：章剑锋[1] 邬祎程[1] 王哲[1] 刘俊[1] 朱丹[1] 周健[1] 赵强[1] 陈安清[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院心脏外科,200025

出　　处：《国际心血管病杂志》2013年第4期256-259,共4页International Journal of Cardiovascular Disease

摘　　要：目的:回顾性总结非体外循环下序贯旁路移植技术同期行内膜剥脱治疗严重弥漫性冠状动脉病变的临床疗效。方法:52例冠心病患者接受非体外循环下冠状动脉旁路移植术,桥血管吻合采用序贯旁路移植技术,并同期行内膜剥脱完善再血管化治疗。分析所有病例的围手术期临床资料,中期随访不良事件的发生率,冠状动脉CTA评价桥血管及吻合口的通畅程度。结果:52例病例共接受移植物82支,平均搭桥(1.6±1.2)支。同期共行内膜剥脱61次,平均内膜剥脱(1.1±0.2)次/例。围手术期死亡3例(5.8%),心肌梗死3例(5.8%)。出院后平均随访时间为(23±5)个月,累计发生死亡6例(11.5%),心肌梗死5例(9.6%),再次血运重建4例(7.7%)。术后1年冠状动脉CTA提示所有吻合口通畅率为93.5%,内膜剥脱后吻合口通畅率略低于未接受内膜剥脱的吻合口(80.6%vs.98.9%,P<0.05)。结论:非体外循环下序贯旁路移植同期行冠状动脉内膜剥脱可安全、有效地实现冠状动脉完全再血管化,近中期效果满意,是治疗弥漫性冠状动脉病变的有效方法。Objective： The aim of this study was to evaluate the effectiveness of simultaneous coronary endarterectomy （CE） in treating diffuse coronary artery disease by off-pump with sequential grafting. Methods： From March 2009 to March 2011,52 consecutive patients underwent off-pump coronary artery bypass sequential grafting with adjunctive CE. Early and mid-term outcomes were retrospectively analyzed. The patency of sequential grafts and anastomoses was evaluated by coronary computed tomographic angiography （CTA）. Results： A total of 82 grafts were bypassed, and 61 vessels were endarterectomized. Operation mortality was 5. 8%. The incidence of perioperative myocardial infarction was 5.80% The mean follow-up time was （23 ± 5） months. Coronary CTA showed that the patency of anastomoses with CE was 80.6% and the patency of anastomoses without CE was 98.9%. Conclusion：These findings indicate that the simultaneous endarterectomy in off-pump coronary artery bypass may be effective and safe for revascularization of diffuse coronary artery disease.

关 键 词：冠心病 冠状动脉旁路移植术 非体外循环 序贯旁路 内膜剥脱 

分 类 号：R654.2[医药卫生—外科学]