分站式杂交手术治疗冠心病多支病变的可行性及安全性分析

Feasibility and Safety of 2-staged Hybrid Technique for Treating Coronary Artery Disease Patients With Multi-vessel Lesions

目的:探讨分站式杂交手术治疗冠心病多支病变的可行性及安全性。方法:2012-03至2015-03期间在本中心行分站式杂交手术的前降支病变及其他非前降支主要血管管径狭窄超过70%的多支病变的91例患者为试验组。同时期由同一术者完成的择期非体外循环下冠状动脉旁路移植术(OPCAB)的91例患者作为对照组。比较两组患者围手术期资料以及并发症发生情况。结果:试验组患者的术后呼吸机使用时间[(7.9±4.8)h vs(21.6±35.9)h]以及监护室时间[(29.6±20.8)h vs(47.5±38.3)h]均显著低于对照组(P均<0.01),试验组患者围手术期的红细胞使用量也明显低于对照组([0.59±1.48)U vs(2.82±3.81)U,P<0.01]。试验组患者的围手术期死亡率、心肌梗死发生率以及切口愈合不良等并发症发生率与对照组相比差异无统计学意义(P>0.05)。结论:对于合并前降支病变的冠心病多支病变患者,分站式杂交手术是一项创伤小、安全可行的技术。

Objective： To assess the feasibility and safety of 2-staged hybrid technique for treating coronary artery disease （CAD） patients with multi-vessel lesions. Methods： Our research included 2 groups： Hybrid group, CAD patients with left anterior descending artery （LAD） lesion or with other major epicardial vessel stenosis〉70% who received 2-staged hybrid treatment in our hospital from 2012-03 to 2015-03 and Control group, CAD patients received elective conventional off-pump coronary artery bypass （OPCAB） by the same surgeon at meanwhile, n=91 in each group. The peri-operative conditions and complications were compared between two groups. Results： Compared with Control group, Hybrid group had the shorter post-operative mechanical ventilation time （7.9 ±4.8） h vs （21.6 ±35.9） h, shorter ICU-stay time （29.6 ±20.8） h vs （47.5 ± 38.3） h, all P〈 0.01 and less peri-operative blood transfusion （0.59± 1.48） U vs （2.82 ± 3.81） U, P〈0.01. The post-operative complications of mortality, MI occurrence and delayed wound healing were similar between 2 groups,P〉0.05. Conclusion：2-staged hybrid technique is a safe, feasible and minimally invasive technique for treating CAD patients with LAD and multi-vessel lesions.