激光血运重建术治疗冠心病的临床研究

Clinical study of transmyocardial laser revascularization treating coronary artery disease

目的:总结分析了99年9月至99年11月激光血运重建术治疗冠心病3例的临床经验。资料及方法:3例冠心病患者均为不稳定性心绞痛,有阵旧性心肌梗塞1例,3例均合并Ⅱ期高血压病。超声心动图左室射血分数在0.57～0.62之间,FS 0.28～0.30。经心肌核素扫描99~M(Ti—MiBi)及心电图检查均提示前壁及下壁缺血。在全麻下经左胸前外侧第5肋间进胸,显露左心室壁,采用高功率二氧化碳激光打孔器(梅曼公司HL-100型)在左室缺血区域打孔8～14个。结果:3例病人术后2周全部康复出院,术后无心律失常,无心衰及心肌梗塞,术后心绞痛症状均全部缓解,一般体力活动不受限制。结论:激光血运重建术治疗冠心病是安全、有效的,对于国人由于冠状动脉血管纤细,激光血远重建术适应证可适当放宽。

Aim: To review the clinical experience of sole transmyocordial laser revascularization (TMLR) in treatment of coronary heart disease (CHD). Clinical material and methods: three cases were all unstable angina. Age was between 45 - 64 years.Past medical history included 100% hypertension,prior AMI 33.3% . Left ventricular efection fraction was between 0.57-0. 62, FS 0.28-0. 30, ECG and SPECT(99m Ti-MiBi) showed anterior and inferior wall ischemia. TMLR was performed on the beating heart via a left anterolaterial thoracotomy in the fifth intercoseal space. CO2 laser mashine ( Meiman HL-100) was used. Transmyocardial penetration unmber was between 8-14 in ischemic zone. Results: The Pe-rioperative mortality was o.There was not post-operative complication,such as AMI,left ventricular failure. Angina were all not existence.Mean recovery time was two weeks.Conclusions:Sole TMLR is a safe and effective procedure for treatment of end stage CHD especially for not amenable to PTCA of CABG.The indication for TMLR should be extended in our country.