“一站式”颈动脉内膜剥脱术联合非体外循环下冠状动脉旁路移植术治疗冠心病合并颈动脉狭窄  

One-stop carotid endarterectomy and off-pump coronary artery bypass grafting for patients with coronary artery disease and carotid artery stenosis

作　　者：黄健兵[1] 姜兆磊[1] 梅举[1] 汤敏[1] 刘浩[1] 沈赛娥[2] 丁芳宝[1] HUANG Jianbing;JIANG Zhaolei;MEI Ju;TANG Min;LIU Hao;SHEN Sai'e;DING Fangbao(Department of Cardiothoracic Surgery,Xinhua Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai,200092,P.R.China;Department of Anesthesiology,Xinhua Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai,200092,P.R.China)

机构地区：[1]上海交通大学医学院附属新华医院心胸外科,上海200092 [2]上海交通大学医学院附属新华医院麻醉科,上海200092

出　　处：《中国胸心血管外科临床杂志》2023年第12期1720-1724,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家临床重点专科;国家自然科学基金项目(82170324;81974023);上海市科委科研计划项目(20Y11910700)。

摘　　要：目的分析“一站式”颈动脉内膜剥脱术(carotid endarterectomy,CEA)联合非体外循环下冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)治疗冠状动脉粥样硬化性心脏病(冠心病)合并颈动脉狭窄的疗效。方法回顾性分析2018年3月—2021年6月在上海交通大学医学院附属新华医院接受“一站式”CEA+OPCABG治疗冠心病合并严重颈动脉狭窄患者的临床资料。患者术前均常规行冠状动脉及颈动脉造影明确诊断冠心病及颈动脉狭窄。所有患者术中均先行CEA,再同期行OPCABG。结果共纳入12例患者,其中男9例、女3例,年龄58~69(63.7±3.4)岁。颈动脉狭窄均为单侧重度狭窄,狭窄程度为70%~90%,病变位置均位于颈动脉分叉或颈内动脉起始段。所有患者均顺利完成“一站式”CEA+OPCABG,术中移植桥血管2~4(2.8±0.6)支,CEA手术时间16~35(25.7±5.6)min。所有患者均顺利康复出院,围术期及随访期间无死亡病例,无脑卒中、心肌梗死等严重并发症。术后随访时间6~40个月,随访期间动脉桥血管通畅率为100.0%(12/12),静脉桥血管通畅率为95.5%(21/22);颈部血管超声显示颈动脉血流通畅,无明显狭窄。结论“一站式”CEA+OPCABG治疗冠心病合并颈动脉狭窄安全、有效,早中期效果满意。Objective To analyze the efficacy of one-stop carotid endarterectomy(CEA)and off-pump coronary artery bypass grafting(OPCABG)for patients with coronary artery disease(CAD)combined with carotid artery stenosis.Methods The clinical data of patients with CAD and severe carotid artery stenosis who underwent one-stop CEA and OPCABG in our department from March 2018 to June 2021 were retrospectively analyzed.Before the surgery,all patients routinely underwent coronary and carotid angiography to diagnose CAD and carotid artery stenosis.All patients underwent CEA first and then OPCABG in the simultaneous procedure.Results A total of 12 patients were enrolled,including 9 males and 3 females,aged 58-69(63.7±3.4)years.All patients had unilateral severe carotid artery stenosis,and the degree of stenosis was 70%-90%.The lesions of carotid artery stenosis were located in the bifurcation of carotid artery or the beginning of internal carotid artery.All patients successfully underwent one-stop CEA combined with OPCABG.The number of bridging vessels was 2-4(2.8±0.6).The operation time of CEA was 16-35(25.7±5.6)min.There was no death during the perioperative or follow-up periods.No serious complications such as stroke and myocardial infarction occurred during the perioperative period.During the follow-up of 6-40 months,the patency rate of arterial bridge was 100.0%(12/12),and that of venous bridge was 95.5%(21/22).Cervical vascular ultrasound showed that the blood flow of carotid artery was satisfactory.Conclusion One-stop CEA and OPCABG can be safely and effectively used to treat CAD and carotid artery stenosis.The early and middle-term curative effect is satisfactory.

关 键 词：颈动脉狭窄 冠状动脉粥样硬化性心脏病 颈动脉内膜剥脱术 非体外循环下冠状动脉旁路移植术 “一站式” 

分 类 号：R654.2[医药卫生—外科学]