使用不同移植物行选择性冠状静脉动脉化的中远期疗效观察  

Mid-to Long-term Outcomes of Different Grafts for Selective Coronary Venous Bypass Grafting

作　　者：张帆[1] 于洋[1] 李京倖[1] 李海涛[1] 高铭鑫[1] 戴龙圣 白辰[1] 王家阳[1] 顾承雄[1] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,北京100029

出　　处：《中国胸心血管外科临床杂志》2015年第3期225-229,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的比较使用乳内动脉和大隐静脉作为桥血管行选择性冠状静脉动脉化搭桥治疗弥漫性右冠状动脉狭窄病变的中远期疗效。方法回顾性分析2003年1月至2012年12月在北京安贞医院行选择性冠状静脉动脉化搭桥75例患者的临床资料,其中术中使用大隐静脉作为桥血管进行心中静脉动脉化搭桥患者54例(大隐静脉桥组);使用乳内动脉作为桥血管进行心中静脉动脉化搭桥的患者21例(乳内动脉桥组)。于2013年11月随访患者的生存情况、近期心绞痛复发率、近期复查超声心动图和冠状动脉血管成像(CTA)等。结果乳内动脉桥组患者总生存率稍高于大隐静脉桥组(100.0%vs.83.3%),但生存曲线分析结果显示两组生存率差异无统计学意义(P=0.055)。部分患者复查CTA结果显示大隐静脉桥组患者(n=39)的桥血管和心中静脉均发生明显栓塞,而乳内动脉桥患者(n=18)的桥血管和心中静脉均有明显显影,保持通畅(P<0.001)。两组患者心功能指标如左心室射血分数(LVEF)值均较术前明显增加,但两组差异无统计学意义。结论选择性冠状静脉动脉化搭桥术过程中,与大隐静脉桥相比,使用乳内动脉桥可以明显提高中远期桥血管和心中静脉的通畅率,是治疗弥漫性右冠状动脉狭窄病变的有效手段。Objective To compare mid- to long-term outcomes of selective coronary venous bypass grafting（SCVBG） using internal mammary artery（IMA） grafts and great saphenous vein（GSV） grafts for surgical treatment of diffuse right coronary artery atherosclerosis. Methods We retrospectively analyzed clinical data of 75 patients undergoing SCVBG in Beijing Anzhen Hospital from January 2003 to December 2012. GSV was used as grafts for SCVBG in 54 patients（GSV group）, and IMA was used as grafts for SCVBG in 21 patients（IMA group）. All the patients were followed up in November 2013. Their survival condition, recent relapse rate of angina, recent echocardiographic results and coronary CT angiography（CTA） were analyzed. Results Overall survival rate of IMA group was slightly higher than that of GSV group（100.0% vs. 83.3%）, but survival curves showed no statistical difference in survival rate between the 2 groups（P=0.055）. Coronary CTA showed significant blockage in GSV grafts and middle cardiac vein in patients in GSV group（n=39）, while IMA grafts and middle cardiac vein in patients in IMA group（n=18） were mostly visible and patent（P〈0.001）. Left ventricular ejection fraction（LVEF） of the 2 groups were significantly higher than preoperative values, but there was no statistical difference between the 2 groups. Conclusion Compared with SCVBG using GSV, SCVBG using IMA can significantly improve mid- to long-term patency of the grafts and middle cardiac vein, and is an efficacious procedure for diffuse right coronary artery atherosclerosis.

关 键 词：弥漫性右冠状动脉狭窄病变 选择性冠状静脉动脉化搭桥 心中静脉 中远期疗效 

分 类 号：R654.2[医药卫生—外科学]