冠状动脉旁路移植联合颈动脉内膜剥脱术治疗冠心病合并颈动脉狭窄的体会

Experience of coronary artery bypass grafting combined with carotid endarterectomy in the treatment of coronary heart diseases and carotid stenosis

目的:总结冠状动脉旁路移植(CABG)联合颈动脉内膜剥脱术(CEA)治疗冠心病合并重度颈动脉狭窄的经验,探讨手术方法及疗效。方法:回顾性分析2011年1月—2020年3月我院37例冠心病合并重度颈动脉狭窄患者行CABG与CEA手术的临床资料。冠状动脉造影显示左主干病变9例,其余均为冠状动脉3支病变;合并单侧颈动脉重度狭窄(≥70%)25例,双侧颈动脉重度狭窄12例。观察其围术期神经系统、循环系统及其他系统并发症的发生情况,并进行门诊随访。结果:CABG同期行CEA 29例,分期手术8例,所有患者均行单侧CEA。围术期无死亡,无心肌梗死及恶性心律失常发生;1例术后3 d出现脑卒中,经康复治疗后左侧肢体肌力3级。术后随访37例,随访率100%,随访10~86个月,所有患者均无新发脑梗死,无精神意识障碍、认知改变。结论:CABG联合CEA治疗冠心病合并颈动脉狭窄安全有效。

Objective:To summarize the effect and safety of coronary artery bypass grafting(CABG)combined with carotid endarterectomy(CEA)in the treatment of coronary heart disease with severe carotid stenosis.Methods:Thirty-seven patients with coronary artery diseases and carotid stenosis underwent CABG and CEA in Affiliated Hospital of Jining Medical University from January 2011 to March 2020 were retrospectively analyzed.Coronary angiography showed that 9 cases of left main coronary artery lesions.The other cases were 3 coronary artery lesions;25 cases were complicated with unilateral carotid stenosis(≥70%),12 cases were bilateral carotid stenosis.The perioperative complications of nervous,circulatory and other systems were observed and followed up.Results:CABG and CEA were performed simultaneously in 29 cases and staged in 8 cases.All patients underwent unilateral CEA.There was no death,myocardial infarction,and malignant arrhythmia during perioperative period.One patient developed stroke 3 days after operation.The left limb muscle strength was grade 3 after rehabilitation treatment.All the cases were followed up for 10-86 months,and there was no new cerebral infarction,mental disturbance,or cognitive change.Conclusion:The combination of CABG and CEA is safe and effective for patients with coronary artery diseases and carotid stenosis.