冠状动脉旁路移植术的中远期效果随访

Mid- and long-term follow-up for the graft patency after coronary artery bypass graft surgery

目的 分析冠状动脉旁路移植术（CABG）的中、远期疗效.方法 CABG术后行多层螺旋CT（MDCT）复查42例,行冠状动脉造影（SCA）复查59例 平均随访（66.79±44.27）个月.其中动脉旁路血管115支,静脉旁路血管195支.分别计算旁路血管的通畅率,比较其间的差异.结果 行MDCT复查者随访（53.93±36.80）个月,LIMA、RA、SV和CV的通畅率分别为94.7%、92.0%、85.9%和60.0% 有心绞痛再发组为83.5%,无心绞痛再发组为95.2%,差异有统计学意义.SCA复查者随访（75.95±47.09）个月,LIMA、RA、SV和CV的通畅率分别为87.1%、81.0%、53.6%和57.1% 有心绞痛再发组为62.0%,无心绞痛再发组为100.0%,差异有统计学意义.结论 MDCT可以作为一种无创检查方法来评价CABG术后旁路血管的通畅情况 动脉旁路血管的中、远期通畅率较静脉高 旁路血管病变是导致术后再发心绞痛的重要原因 旁路血管病变程度与CABG术后的随访时间密切相关.

Objective To analyze the mid- and long-term results after coronary artery bypass graft surgery （CABG）, to evaluate the accuracy of multi-detector CT coronary angiography （MDCT） on the graft patency status and to compare the patency for different grafts. Methods One hundred and one cases underwent CABG from June 1992 to March 2008 were followed up by searching the database of MDCT （42 cases） and selective coronary angiography （SCA, 59 cases）. The mean following up period was （66.79 ±44.27） months. Three hundreds and 10 grafts including 115 arterial and 195 venous were analyzed.A comparison of the patency rate between the arterial and venous grafts was also carried out. At the mean time, 2 groups were divided according to the paft lesions（ patency of not）. Uunivariate analysis and Logistic regression analysis were made for statistics. Results At the follow-up of （53.93 ± 36.80） months, the patent rate of LIMA, RA, SV and CV examined by MDCT was 94.7%, 92.0%, 85.9% and 60.0%, respectively. The patent rate for MDCT patients with angina was 83.5%, and 95.2% for angina-free group （ P = 0.046）. At the follow-up of （75.95 ±47.09） months, the patent rate of LIMA, RA, SV and CV examined by SCA was 87.1%, 81.0%, 53.6% and 57. 1%, respectively. In SCA patients the patent rate was 62.0% for angina group and 100% for angina-free group （ P = 0.025 ）. According to logistic regression analysis, only the postoperative period was statistically related to the graft lesion. Conclusion MDCT could find out the occlusions and obvious stenoses of the grafts after CABG. It might be served as a noninvasive method to evaluate the grafts patency postoperatively. The mid- and long-term patency of arterial grafts is better than venous grafts. Graft lesion is an important factor leading to postoperative recurrent angina pectoris. The severity of the graft lesion has a close relation to the lenth of postoperative period.