“一站式”Hybrid手术治疗冠状动脉多支病变的初步体会

Preliminary experience of ＂one-stop＂ Hybrid operation in treatment of multivessel coronary artery disease

目的探讨“一站式”Hybrid技术在冠状动脉旁路移植手术中的应用价值及临床近中期疗效。方法回顾性分析2013年5月—2014年5月在安徽医科大学第一附属医院心脏血管外科一病区接受“一站式”Hybrid手术治疗的7例冠状动脉多支病变患者的资料并随访，手术由同一组医生完成。病例入选标准为：前降支病变较重不适合置入支架、非前降支适合置入支架的冠状动脉多支病变患者。其中男6例、女1例，年龄54—77岁，SYNTAX评分为27—36分。7例患者中左主干皆正常，左前降支近中段长段狭窄或多处狭窄大于85％5例，左前降支近中段闭塞性病变2例，回旋支及右冠状动脉均存在1～2处局限性狭窄，均有陈旧性心肌梗死，合并糖尿病3例。左室射血分数55％～65％，平均57．13％。结果手术后无死亡；7例Hybrid患者术后即刻行冠状动脉造影及乳内动脉桥造影显示，吻合口及支架置入处通畅满意。随访1～12个月，所有患者心绞痛症状消失。手术后心电图检查无一例新增心肌梗死出现。结论对于前降支不适合置入支架，非前降支适合置入支架的冠状动脉多支病变患者采用“一站式”Hybrid技术，有较好的临床疗效。个体化的微创手术方法才会使患者真正受益。

Objective To explore application and clinical mid-term effect of one-stop hybrid technique on coronary artery bypass graft surgery （CABG）. Methods An retrospective analysis and follow- up were performed for a total of 7 patients with muhivessel coronary disease treated by one-stop hybrid surgery in Department of Cardiovascular Surgery （Ⅰ） of the First Affiliated Hospital of Anhui Medical University from May 2013 to May 2014. All surgeries were completed by the same doctors. The inclusion criteria for all patients were worse disease of anterior descending not suitable for stent implantations and non- anterior descending disease suitable for stent implantations. There were 6 male patients and 1 female patient with the age from 54 to 77 years. The scores of SYNTAX were from 27 to 36. The condition of left main coronary of patients was normal, meanwhile, proximal or multi-stenosis larger than 85% of left anterior descending were found in 5 patients and proximal occlusion was found in the other 2 patients ; 1 - 2 restricted stenosis lesions were found in both circumflex branch and right coronary artery. All of patients had the past history of old myocardial infarction, three of whom complicated with diabetes mellitus, With 56% -65% of ejection fraction, the mean value was 57. 13%. Results No deaths were found after surgeries. The angiographies of coronary and internal mammary artery were performed immediately after surgeries and all stomas were kept unobstructed. No symptoms of angina in survival patients were found after a follow-up of 1 - 12months. No new cases of myocardial infarction were observed by the electrocardiogram after surgeries. Conclusions One-stop hybrid technique is suitably applied to patients who are not applicable to stent implantations with anterior descending artery disease and applicable to stent implantations with multivessels coronary disease. Patients can share actual benefits through individual micro-invasive surgeries.