冠心病的外科治疗

Surgical treatment of coronary heart disease

目的 总结 5年来外科治疗冠心病的近期疗效。方法 397例冠心病患者中 ,男 337例 ,女 6 0例 ,平岿年龄为 (6 4 .5± 9.2 )岁。行冠状动脉搭桥术 36 6例 (其中搭桥加激光心肌血运重建术 4 4例 ) ,行单纯激光心肌血运重建术 2 7例 ,行室壁瘤切除术 3例 ,行室壁瘤切除加二尖瓣置换术 1例。急诊手术 5例。不停跳搭桥冠状动脉旁路移植术 6 9例。 2 0 3例采用乳内动脉移植 ,4 6例采用桡动脉移植 ,2例采用胃网膜动脉移植。结果 住院期间死亡 10例 ,死亡率为 2 .5 % (10 /397例 )。存活者中 5 6例 (14 .5 % ,5 6 /387例 )发生各种并发症。 5 9例行激光心肌血运重建术治疗的患者平均随访 13.9个月。结论 本组患者平均年龄大 ,高龄是死亡的重要危险因素 ,激光治疗能缓解心绞痛 。

Objective To summarize the short-term efficacy of surgical treatment of coronary heart disease in recent 5 years. Methods There were 337 males and 60 females among the 397 cases with a mean age of (64.5±9.2) years. Coronary artery bypass grafting was performed in 366 cases (including coronary artery bypass grafting+transmyocardial laser revascularization in 44 cases) and isolated transmyocardial laser revascularization in 27 cases; excision of ventricular aneurysm in 3 cases; excision of ventricular aneurysm plus mitral valve replacement in 1 case. There were 5 cases with emergency operation and 69 cases with off-pump CABG. Internal mammary arteries were adopted in 203 cases; radial artery in 46 cases and gastroepiploic artery in 2 cases. Results There were 10 hospital deaths, the mortality rate was 2.5%. 56 survived patients were suffered from complications. 59 cases who received laser therapy were followed up for a mean duration of 13.9 months. Conclusion The mean age of patients of the present series is elder and senility is an important risk factor of hospital death. Laser therapy can relieve the angina. The indication of interventional therapy should be handled appropriately.