冠状动脉内膜剥脱术在冠心病外科治疗中的应用

Application of coronary endarterectomy in surgical treatment of coronary heart disease

目的探讨冠状动脉内膜剥脱术在冠心病外科治疗中的应用,评估其临床疗效.方法我科自2013年10月至2017年10月进行19例冠心病患者接受非体外循环冠状动脉旁路移植术,术中运用冠状动脉内膜剥脱术,分析围手术期临床资料,中期随访不良心血管事件的发生率,总结冠状动脉内膜剥脱术的技术要点.结果 19例病例术中共行冠状动脉内膜剥脱35处,其中前降支系统7支(37%,其中前降支5支、对角支2支),回旋支系统2支(10%),右冠状动脉系统10支(53%,其中主干4支、后降支6支);4例患者同时行2支血管内膜剥脱.患者无围术期心肌梗死和手术死亡;中期随访无心绞痛发作,术后1年冠状动脉CTA提示所有吻合口通畅率为92.5%.结论冠状动脉内膜剥脱术能安全、有效地实现冠状动脉完全再血管化,近中期效果满意,是治疗弥漫性冠状动脉病变的有效方法.

Objective To study the application of coronary endarterectomy in the surgical treatment of coronary heart disease and evaluate the early stage effect. Methods 19 patients with coronary artery disease received off^pump coronary artery bypass grafting from October 2013 to October 2017. Coronary endarterectomy was performed during the operation. The perioperative clinical data were analyzed. The incidence of adverse events was followed up in the middle term. Results There were 35 coronary endarterectomy sites in 19 cases, including 7 anterior descending branches (37%, 5 of anterior descending branch, 2 diagonal branches), 2( 10%) and 10 of right coronary artery system ( 53%. 4 trunk and 6 descending branch) and 4 patients were subjected to carotid endarterectomy at the same time. There was no perioperative myocardial infarction or operative death and no angina pectoris attack was found in the mid-term follow-up. The patency rate of all anastomotic stomas was 92.5% by coronary CTA one year after operation. Conclusion Coronary endarterectomy is a safe and effective method to achieve complete revascularization of coronary artery with satisfactory results in the near and medium term. It is an effective method to treat diffuse coronary artery disease.