分站式杂交手术在冠状动脉狭窄的临床应用  

Clinical Experience and study of 2-staged hybrid surgery in coronary stenosis

作　　者：庞中一 王伟 周研 马永强 樊国亮 孙公平 PANG Zhongyi;WANG Wei;ZHOU Yan;MA Yongqiang;FAN Guoliang;SUN Gongping(Department of Cardiac and Macrovascular Surgery,Deyu Medical Maanshan General Hospital,Maanshan 243000,China)

机构地区：[1]德驭医疗马鞍山总医院胸心外科,243000

出　　处：《心肺血管病杂志》2024年第11期1179-1184,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：马鞍山市科技计划项目(YL-2021-22)。

摘　　要：目的:评估择期“分站式”杂交手术治疗冠状动脉多支血管病变的早中期的疗效及安全性。方法:2021年2月至2023年1月,共116例冠状动脉多支血管病变在我院及合作医院完成手术,其中行“分站式”杂交手术的患者45例为观察组(HCR组),同时随机选取同一手术团队完成的非体外循环冠状动脉移植手术患者71例为对照组(OPCAB组),进行回顾性研究比较。所有患者术后3、6个月及1年进行门诊复查随访。结果:观察组无死亡,对照组患者1例住院期间死亡。在术后观察组及对照组总引流量[260.0(215.0,395.0)vs.600.0(490.0,722.5)mL,P<0.001]、机械通气时间[3.5(2.5,5.0)vs.5.0(3.0,8.3)h,P<0.001];cTnI术后24h数值[0.08(0.1,0.1)vs.0.9(0.2,1.9)μg/L,P<0.001]。所有患者全部进行了随访从3个月~1.7年。杂交手术后,无再入院,无再发脑梗死、心绞痛再发和心肌梗死,无再次移植及计划外住院PCI治疗。结论:“分站式”杂交手术是一种安全、有效的手术方式,其围手术期和中期随访结果满意,更适合于我国国情,适用于合并前降支严重病变无法接受PCI治疗而右冠状动脉或(和)左回旋支等非前降支病变可以进行PCI治疗的冠状动脉粥样硬化多支病变者。Objective:To evaluate the efficacy and safety of selective operation of"2-staged"hybrid procedure in the treatment of coronary multivessel lesions.Methods:A total of 116 patients who received surgery in our hospital from 2021-02 to 2023-01 were summarized.The patients were divided into 2 groups,patients(n=45)with 2-staged hybrid procedure(HCR)group was experimental group patients(n=71)with only OPCAB procedure was matched group.Conduct a retrospective study for comparison.All patients had outpatient review follow-up at 3 months,6 months,and one year after surgery.Results:All patients in HCR groups finished 2-staged hybrid procedure successfully,no peri-operative death and no severe complication.One patient appear ventricular fibrillation and blood pressure decreased to complete bypass on pump during the OPCAB.The post-operative chest drainage volumes in HCR group and OPCAB group were[260.0(215.0,395.0)vs.600.0(490.0,722.5)mL,P<0.001].Ventilator-assisted time in HCR group and OPCAB group were[3.5(2.5,5.0)vs.5.00(3.0,8.3)h,P<0.001].Values of TNI at 24h post-operativein HCR group and OPCAB group were[0.1(0.1,0.1)vs.0.9(0.2,1.9)μg/L,P<0.001].The patients were followed-up for 3-12 months,there were no death,no myocardial infarction or angina in HCR grop,one death in OPCAB group.There were 0 cases of redo bypass and unplanned inpatient PCI treatment.Conclusion:Two-staged hybrid procedure is a safe and effective surgical method,its perioperative and mid-term follow-up results are satisfactory,more suitable for China's national conditions.Coronary atherosclerotic lesions with severe LAD lesions that cannot receive PCI and non-LAD lesions like RCA or(and)LCX can be treated with PCI.

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

分 类 号：R54[医药卫生—心血管疾病]