冠状动脉内膜剥脱在冠状动脉旁路移植术治疗中的临床评价

Clinical evaluation of treatment of coronary endarterectomy in coronary artery bypass grafting

目的总结冠状动脉内膜剥脱(CE)在冠心病心肌血运重建中应用的临床疗效。方法 76例行冠状动脉旁路移植术(CABG)的患者分为两组:对照组:单纯行CABG术(36例);CE组:行CE+CABG术(40例),对比分析两组病例的围术期临床资料,术后1年心绞痛的缓解情况及冠状动脉CTA评价吻合口及桥血管通畅情况。结果 76例患者共接受移植血管162支,平均搭桥(2.1±0.8)支,同期行内膜剥脱43次,两组围术期资料及术后1年心绞痛症状缓解情况差异不具有统计学意义(P>0.05);术后1年随访54例患者接受冠状动脉CTA检查,结果显示所有吻合口通畅率为95.0%,CE组与对照组吻合口完全闭塞率(22.2%vs.1.7%,P<0.01)及通畅率(77.8%vs.98.3%,P<0.05)差异具有统计学意义;所有桥血管通畅率为88.3%,CE组与对照组桥血管完全闭塞率(22.2%vs.7.9%,P<0.01)及通畅率(77.8%vs.92.1%,P<0.05)差异具有统计学意义。结论 CABG术同期行CE可以增加冠状动脉血运重建机会,提高冠状动脉再血管化程度,改善靶血管吻合口条件和治疗效果。

Objective To summarize the clinical effectiveness of the coronary endarterectomy（ CE） in myocardial revascularization. Methods Seventy-six cases underwent coronary artery bypass grafting（ CABG） were divided into two groups,36 patients only accepted CABG as control group and 40 patients accepted CE ＋ CABG as CE group. Clinical data of peroperative period,remission of angina pectoris and patency rate of anastomotic stoma and bridge blood vessel evaluated through coronary CTA were analyzed contrastively. Results A total of 162 grafts were bypassed,and 43 vessels were endarterectomized. The difference of clinical data of peroperative period and remission of angina pectoris one year after operation was not significant（ P〉0. 05）; 54 cases accepted coronary CTA check at follow up and results showed that patency rate of all anastomotic stoma was 95. 0%,and occlusion rate of anastomotic stoma in CE group was significantly higher than control group（ 22. 2% vs. 1. 7%,P〈0. 01） and patency rate in CE group was significantly lower than that in control group（ 77. 8% vs. 98. 3%,P〈0. 05）. Patency rate of all bridge blood vessels was 88. 3%,and occlusion rate of bridge blood vessel in CE group was significantly higher than bridge blood vessel in control group（ 22. 2% vs. 7. 9%,P〈0. 01） and patency rate in CE group was significantly lower than that in control group（ 77. 8% vs. 92. 1%,P〈0. 05）. Conclusion CABG associated with CE is an effective technique in myocardial revascularization,which can increase the degree of revascularization and improve the conditions of target vascular anastomosis and therapeutic effect.