左主干狭窄的外科治疗

Surgical treatment of left main stenosis in coronary artery disease

目的 探讨左主干狭窄 (LMS)≥ 5 0 %患者的外科治疗效果。 方法 42例LMS的患者接受了冠状动脉旁路移植术 (CABG)。平均年龄 6 8 7岁。LMS介于 5 0 %～ 75 %者 16例 ,大于 75 %者2 6例。不稳定型心绞痛 2 9例。按CCSS标准心绞痛分级 ,Ⅰ级 2例 ,Ⅱ级 5例 ,Ⅲ级 17例 ,Ⅳ级 18例。左室射血分数小于 5 0 %者 2 4例。 结果 术前平均住院时间 2 3d ,人均移植血管 3 3根 ,无手术死亡。术后所有患者心绞痛均消失。随访 3～ 78个月 ,平均 42个月 ,无死亡发生。 结论 CABG是治疗LMS的第一选择 ,它是一种安全、有效的方法。把握适当的手术时机 ,对减少术前心脏意外事件发生和提高手术疗效相当关键。同时对LMS的手术技巧、心肌保护、升主动脉钙化、IABP应用 。

Objective[WT5”BZ] To study the efficacy of surgical treatment in the patients with left main stenosis of 50% or more. [WT5”HZ] Methods[WT5”BZ] Forty two patients with left main stenosis (LMS) underwent coronary artery bypass grafting (CABG). Their mean age was 68.7 years. 16 patients had 50% to 75% LMS and 26 patients more than 75%. Twenty nine patients had unstable angina. Seventeen patients with angina were in class Ⅲ according to CCSS and 18 were in class Ⅳ. Preoperative left ventricular ejection fraction in 24 patients was beyond 50%.[WT5”HZ]Results[WT5”BZ] The mean preoperative hospital stay was 2.3 days. The mean number of grafts was 3 3 per patient. There was no operative death. The patients were all free from angina postoperatively. The mean follow up time was 42(3～78) months without death. [WT5”HZ]Conclusions[WT5”BZ] Coronary artery bypass grafting is the first choice to treat left main stenosis. It is a safe and effective method. To determine properly the time of surgical intervention is helpful to reduce preoperative cardiac affairs and improve operative efficacy. [WT5”HZ]