分站式杂交手术治疗冠状动脉多支血管病变的临床经验  

Clinical experience of two-staged hybrid procedure for performing the coronary artery revascularization

作　　者：李育敏[1] 赵龙[1] 李淑珍[1] 王坚[1] 张玉龙[1] 

机构地区：[1]内蒙古医科大学附属医院心脏外科,内蒙古呼和浩特010050

出　　处：《哈尔滨医科大学学报》2017年第3期277-280,共4页Journal of Harbin Medical University

摘　　要：目的总结经左胸小切口冠状动脉旁路移植术(minimally invasive direct coronary artery bypass,MIDCAB)与经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)相结合的分站式杂交(hybrid)手术治疗冠状动脉多支血管病变的临床经验。方法收集内蒙古医科大学附属医院2013年6月~2016年4月共15例冠脉多支病变患者接受MIDCAB和PCI相结合的分站式杂交手术治疗,通过临床资料、治疗方法、随访结果进行回顾性分析。结果 15例冠脉多支血管病变患者的分站式杂交手术均顺利完成。全部行左侧内乳动脉至前降支冠状动脉旁路移植术,经PCI术共置入药物洗脱支架34枚,围手术期无严重并发症及死亡。患者MIDCAB术后胸腔引流量不多,恢复顺利;术后随访6个月均生存良好,无再次入院,无心肌梗死或心绞痛症状发生,无脑梗死、肾功能衰竭。复查冠脉CT检查未见明显异常。结论严格执行围手术期抗凝策略下的分站式杂交手术治疗冠状动脉多支血管病变微创、有效、安全可行。Objective To summarize the clinical experience of minimally invasive direct coro- nary artery bypass （MIDCAB） and percutaneous coronary intervention （PCI） （two-staged hy- brid procedure） for treating the patients with multi-vessel lesions. Methods A total of 15 cor- onary artery disease patients with multi-vessel lesions including left anterior descending artery （LAD） stenosis were treated in The Affiliated Hospital of Inner Mongolia Medical University from June 2013 to April 2016. All the patients received two-staged hybrid coronary artery revas- cularization. The clinical data, surgical method, follow-up results were analyzed retrospective- ly. Results All patients finished the two-staged hybrid procedure successfully. Left internal mammary artery （LIMA） to left anterior descending coronary artery （LAD） was performed on all patients and 34 drug eluting stents were implanted by PCI with no peri-operative death and severe complication. The post-operative chest drainage volumes after MIDCAB group were less. The patients were followed up for 6 months, and there were no death, no myocardial infarction or angina, no cerebral infarction and renal failure. No significant abnormality was found in CT examination. Conclusion With intensive anticoagulation and antithrombotic treatment, two- staged hybrid procedure is safe and feasible for performing the coronary artery revascularization.

关 键 词：左胸小切口 冠状动脉旁路移植术 经皮冠状动脉介入治疗 分站式杂交手术 

分 类 号：R654.2[医药卫生—外科学]