31例冠状动脉旁路移植术同期左室室壁瘤切除的疗效

The surgical treatment for left ventricular aneurysm combined with coronary artery bypass grafting in 31 cases

目的探讨冠状动脉旁路移植术同期左室室壁瘤切除的手术治疗效果。方法回顾性分析新疆医科大学第一附属医院2010年1月至2012年8月31例冠状动脉旁路移植术同期行左室室壁瘤切除术患者的病例资料，对其进行整理统计分析，评价治疗效果。结果患者术后左心室舒张末期较术前明显缩小，差异有统计学意义（P〈0．05）；左心室射血分数较术前明显升高，差异有统计学意义（P〈0．05）。术后出现低心排综合征4例，室性心律失常2例，脑梗塞1例。围术期死亡2例，均死于严重低心排综合征。通过电话随访及门诊复查，随访28例，随访率90．3％，随访时间5个月，随访期间无远期死亡。结论冠状动脉旁路移植术同期左室室壁瘤切除术后疗效满意。根据患者室壁瘤的大小和病变程度合理选择手术方式、适宜的左室重建及有效的心肌保护是手术成功的关键。

Objective To explore the surgical treatment for left ventricular aneurysm combined with coronary artery bypass grafting. Methods In this method review, 31 cases of clinical documents have been analyzed, which is due to left ventricular aneurysm combined with coronary artery bypass grafting from January 2010 to August 2012. And evaluating its therapeutic effects. Results The patient of postoperation, the left ventrieular enddiastolic diameter compared with the preoperation was significantly decreased （P〈0.05）, and the left ventrieular ejection fraction was significantly increased compared with the preoperative （P〈0.05）. After operation, four cases had low cardiac output syndrome, two cases had ventricular arrhythmias, one case had cerebral infarction. Two cases were dead in perioperative. In 31 cases, 28 cases （90.3%） were followed up for five months. Conclusion The surgical treatment for left ventricular aneurysm combined with coronary artery bypass grafting were satisfactory, according to the size and severity of the patient＇s aneurysm, choosing reasonable surgical approach and suitable reconstruction of the left ventricular and protection of myocardial effectively is the key to successful operation.