同期颈动脉内膜切除术与冠状动脉搭桥术治疗颈动脉合并冠状动脉狭窄15例临床经验

Simultaneous carotid endarterectomy and coronary artery bypass grafting for the treatment of combined carotid and coronary artery stenosis, report of 15 cases

目的评价同期联合行颈动脉内膜切除术（carotid endarterectomy,CEA）与冠状动脉搭桥术（coronary artery bypass grafting,CABG）治疗颈动脉与冠状动脉狭窄并存疾病的早期临床疗效。方法2000年1月至2006年8月对15例颈动脉与冠状动脉狭窄并存患者实施了同期CEA与CABG手术。男性12例,女性3例,年龄63～80岁,平均（70±6）岁。所有患者术前均行冠状动脉造影与颈动脉造影术明确诊断,其中冠状动脉左主干病变3例,2支血管病变2例,3支血管病变10例。手术先行CEA再行CABG 14例,1例患者先行CABG后行CEA,有5例患者在体外循环（CPB）下完成CABG,其余10例在非体外循环下行CABG;在行CEA时,所有患者均使用颈动脉转流管,所有患者均采用人工血管补片加宽颈动脉切口。结果本组无手术死亡,围手术期无心脑血管并发症发生,1例患者手术后1个月因右下肢动脉硬化闭塞症而行右下肢股-腘动脉人工血管搭桥术。术后随访3～24个月,患者无心绞痛,短暂性缺血性脑发作（TIA）或脑中风发生。结论同期行颈动脉内膜切除术与冠状动脉搭桥术治疗颈动脉与冠状动脉狭窄并存疾病方法可行,早期效果满意。

Objective To assess the safety and early results of combined carotid endarterectomy （CEA） and coronary artery bypass grafting （CABG） in patients with coexistent cerebral and coronary artery stenosis. Methods From January 2000 to August 2006, combined CEA and CABG was performed on 15 patients, among them 12 cases were male, 3 cases were female, age ranging from 63 to 80 years. Preoperative angiography revealed： left main trunk stenosis in 3 cases, double vessels involved in 2 cases, triple vessels in 10 cases. CEA was performed first with the aid of temporary carotid artery shunt stent, CABG was performed with cardiopulmonary bypass （CPB） in 5 cases, without CPB in 10 cases. Results There was no operative mortality, nor perioperative cardio-cerebral vascular accident, right femopopliteal artificial graft bypass was performed in 1 case 1 month after the procedure for the arteriosclerotic vascular occlusion of the lower limb. Postoperative follow-up of 3-24 months found no angina pectoris, no cerebral stroke nor transient ischemic attack in all cases. Conclusions This combined procedure for patients with concomitant carotid and coronary artery stenosis is feasible with satisfactory early results.