冠状动脉旁路移植术联合内膜剥脱术的中远期疗效分析

Mid-long term curative result of coronary artery bypass grafting and coronary endarterectomy

目的探讨冠状动脉内膜剥脱在弥漫性冠状动脉病变患者外科治疗的中远期疗效。方法选取2013年12月至2019年12月安贞医院单一医疗组施行的58例冠状动脉旁路移植术(CABG)联合冠状动脉内膜剥脱术(CE),行常规旁路移植术388例,通过1∶1倾向性评分匹配(PSM)得到CE+CABG组和CABG组各58例,分析两组患者的围术期资料。术后随访9~74个月,评价桥血管通畅性,绘制生存分析曲线,评价患者中远期疗效。结果两组在术后30d病死率、围术期心肌梗死、卒中、主动脉内球囊反搏使用率、重症监护室时间、血管移植数等方面差异无统计学意义,但手术时间有明显差异[(263.59±50.34)min比(234.58±46.97)min,P<0.01]。随访9~74个月,CE+CABG组1例死亡,CABG组无死亡,两组中远期生存率无明显差异,中远期桥血管通畅率无明显差异。结论 CE+CABG能实现弥漫性冠状动脉病变血运重建,但CE+CABG组与单独CABG组中远期疗效无明显差异。

Objective To investigate the mid-long term result of surgical treatment for diffused coronary atherosclerosis. Methods From December 2013 to December 2019,58 cases of coronary artery bypass graft(CABG) combined with coronary artery endarterectomy(CE) and 388 cases of conventional coronary artery bypass graft were performed in the same medical team of Anzhen Hospital. Getting 58 cases CE + CABG and also in isolated CABG by 1∶1 propensity score matching, the perioperative data of the two groups were collected and analyzed. During the follow-up period,coronary CT reexamination or coronary radiography was performed to evaluate the patency of the bridge vessels and evaluate the median and long-term result by the survival analysis curve. Results There were obvious differences in operation time between the 2 groups [(263.59 ± 50.34)min vs.(234.58 ± 46.97)min, P<0.01]. However, there were no difference in the postoperative 30-day mortality,perioperative myocardial infarction,stroke, in-aortic balloon pump, intensive care unit time and bypass number etc. Follow-up 9-74 m,1 patients died in the CE+CABG group and no patient died in CABG group;there were no obvious difference in mid-long term survival rate(P>0.05) between the 2 groups. In addition,there were no significant difference in the long-term bridge vessels patency rate(P>0.05). Conclusions CE+CABG can achieve revascularization in diffused coronary artery disease and there are no obvious difference between CE+CABG and isolated CABG group about surgical efficacy in the mid-and long-term.