分站式杂交手术治疗冠状动脉多支血管病变

The Clinical Experience of 2-staged Hybrid Procedure for Performing the Coronary Artery Revascularization

目的： 总结左胸小切口冠状动脉旁路移植术（MIDCAB）与经皮冠状动脉介入治疗（PCI）相结合的分站式杂交 （Hybrid）手术治疗冠状动脉多支血管病变的临床经验。 方法： 2012-05 至 2013-10，87例患者接受 MIDCAB，其中 63 例为单纯 MIDCAB 手术（单纯 MIDCAB 组），24例患者接受MIDCAB和PCI相结合的分站式Hybrid手术（Hybrid组）。Hybrid组冠状动脉造影提示严重的前降支病变， 合并回旋支、右冠状动脉的病变。Hybrid 组在 MIDCAB 围术期接受严格的抗凝和抗血小板治疗。 结果： 24例分站式 Hybrid 手术均顺利完成。围术期无死亡及严重并发症。术后胸腔引流量，单纯 MIDCAB 组与 Hybrid 组相比差异无统计学意义 [（382±138）ml vs（ 520±190）ml， P =0.47]。随访 1-11 个月，两组均无死亡病例， 无心肌梗死或心绞痛发生。Hybrid 组 23例患者术后冠状动脉造影检查均提示乳内动脉桥通畅。 结论：执行严格抗凝和抗血小板治疗的分站式 Hybrid 手术安全可行。

Objective： To summarize the clinical experience of coronary artery bypass grafting via left anterior small thoracotomy （MIDCAB） and percutaneous coronary intervention （2-staged hybrid procedure） for treating the patients with multi-coronary branch lesions. Methods; A total of 87 patients who received MIDCAB in our hospital from 2012-05 to 2013-10 were summarized. The patients were divided into 2 groups, MIDCAB group, n=63 patients with only MIDCAB procedure, and Hybrid group, n=24 patients with 2-staged hybrid procedure. Coronary angiography （CAG） indicated that the patients in Hybrid group had serious lesions of left anterior descending artery combining with left circumflex and right coronary artery Lesions, and those patients received intensive anticoagulation and antithrombotic treatment during peri-operative time. Results： All patients in Hybrid group finished the 2-staged hybrid procedure successfully, no peri-operative death and no severe complication. The post-operative chest drainage volumes in MIDCAB group and Hybrid group were similar, （382±138） ml vs （520±190） ml, P=0.47. The patients were followed-up for 1-11 months, there were no death, no myocardial infarction or angina in neither group. There were 23/27 patients in Hybrid group received post-operative CAG examination and no re-stenosis in internal mammary artery was observed. Conclusion： With intensive anticoagulation and antithrombotic treatment, 2-staged hybrid procedure is safe and feasible for performing the coronary artery revascularization.