经皮冠状动脉腔内成形术后冠状动脉再狭窄的外科治疗

Surgical myocardial revascularization for post-PTCA coronary artery restenosis

目的 探讨经皮冠状动脉腔内成形术 (PTCA)后冠状动脉再狭窄的治疗方法。方法 分析 2 5例PTCA术后冠状动脉再狭窄接受冠状动脉旁路移植手术 (CABG)患者的PTCA前后的临床资料。PTCA后心绞痛症状未缓解者 5例 ,术后 2天至 17个月复发心绞痛 2 0例 ,平均再狭窄发生时间PTCA后 4 6个月。一次PTCA后选择CABG者 19例 ,2次 4例 ,3次 2例。除PTCA或支架部位处发生再狭窄外 ,5例狭窄以远冠状动脉病变加重 ,2例出现左室室壁瘤。结果 2 5例患者共移植旁路 79支(平均 3 2支 ) ,术后心绞痛症状消失。随诊 14例 ,时间为 2～ 15个月 (平均 7 7个月 )。 1例术后 6个月出现胸闷 ,余无心绞痛 ,心功能Ⅰ～Ⅱ级。结论 PTCA后冠状动脉再狭窄的治疗方法应视冠状动脉病变分布特点而定 ,微创冠状动脉旁路移植术适应于前降支病变 ,其创伤小 ,远期疗效佳 ;多支弥漫性病变者应选择常规CABG充分血运重建 ,可获得满意的近、远期疗效。

Objective To assess the treatment selection of post-PTCA restenosis. Methods Twenty-five cases of coronary angioplasty bypass grafting (CABG) after a post-percutaneous transluminal coronary angioplasty (PTCA) restenosis were investigated. After PTCA, unstable angina remained in 5 cases and angina appeared from 2 days to 17 months in 20 cases, the average time of restenosis was 4 6 months. CABG were done in 25 cases after PTCA (19 cases after 1, 4 cases after 2 and 2 cases after 3 times of PTCA). Besides the stenosis recurred at the site of PTCA and stents, the lesion extended beyond the site in 5 cases and the left ventricular aneurysm appeared in 2. Results In 25 cases bypass graft totaled to 79 vessels (average 3 2 vessels each). After surgical treatment, all cases were free of angina and with heart function of grade Ⅰ-Ⅱ (NYHA). Conclusions This study shows that the treatment selection of post-PTCA restenosis should be circumspect. Minimarry invsive direct coronary artery by pass was recommended for single vessel restenosis. CABG would be the first consideration for restenosis of multi-vessels cases with diffuse lesion.