“一站式”行胸主动脉腔内修复术联合冠状动脉旁路移植术的临床经验

发布时间：2018-05-08 17:31

本文选题：冠状动脉旁路移植术 + 血管成形术　；参考：《中国循环杂志》2017年06期

【摘要】：目的:探讨胸主动脉腔内修复术(TEVAR)联合冠状动脉(冠脉)旁路移植术(CABG)"一站式"治疗冠心病合并胸主动脉疾病的安全性及其临床策略。方法:回顾性分析2009-04至2016-01间,在阜外医院血管外科中心接受"一站式"TEVAR联合CABG手术治疗冠心病合并胸主动脉疾病患者20例,男性18例,平均年龄[65.2±8.5(51~82)]岁。分析"一站式"手术的实施策略及围手术期注意事项。结果:20例患者,1例植入胸主动脉支架2枚,19例植入胸主动脉支架1枚,其中3例分别同期实施腹主动脉覆膜支架植入术1例、右侧髂总动脉支架植入术1例和颈动脉内膜剥脱术1例;平均冠脉搭桥[2.4±0.94(1~4)]支,10例(50%)采用乳内动脉桥。20例患者平均住院时间[22.4±11.6(8~58)]天,6例(30%)患者接受输血治疗;低心排综合征1例(5%),采用体外膜氧合器(ECMO)辅助治疗,后又因胸液多二次开胸止血;术后30天死亡2例(10%)。17例患者(失访1例)均获得门诊或电话随访,平均随访时间[13.4±13.6(1~49)]个月,2例患者分别于术后12个月、49个月因脑血管意外去世,15例患者临床症状消失或明显减轻,生活质量改善,无手术相关死亡。结论:TEVAR联合CABG"一站式"治疗冠心病合并胸主动脉疾病中期疗效满意,若需同期行去分支手术为TEVAR创造锚定区,会增加手术时间和手术风险。
[Abstract]:Objective: to investigate the safety and clinical strategy of thoracic aortic endovascular repair combined with coronary artery bypass grafting (CABG) in the treatment of coronary heart disease with thoracic aortic disease. Methods: from 2009-04 to 2016-01, 20 patients with coronary heart disease complicated with thoracic aortic disease were treated with "one-stop" TEVAR combined with CABG operation in vascular surgery center of Fuwei Hospital. This paper analyzes the implementation strategy of "one-stop" operation and points for attention in perioperative period. Results one of 20 patients with thoracic aortic stents was implanted with 2 thoracic aortic stents and 19 patients with thoracic aortic stents, 3 of them received abdominal aortic stent implantation simultaneously. Right common iliac artery stent implantation in 1 case and carotid endarterectomy in 1 case, mean coronary artery bypass graft (2. 4 卤0. 94 卤1 / 4) and coronary artery bypass graft in 10 cases (n = 50) were treated with medial mammary artery bridge (n = 20), mean hospitalization time [22.4 卤11. 6 (8 / 58)] (n = 6) were treated with blood transfusion (n = 30). One patient with low cardiac output syndrome was treated with extracorporeal membrane oxygenator ECMO-assisted treatment, and then the bleeding was hemostatic for more than two times because of pleural effusion, and 2 patients died 30 days after operation, all of them received out-patient or telephone follow-up. The mean follow-up time [13.4 卤13.6U _ (49)] months was 12 months and 49 months after operation respectively. The clinical symptoms of 15 patients died of cerebrovascular accident disappeared or obviously alleviated, the quality of life improved, and there were no operation-related deaths. Conclusion the effect of "one stop" combined with CABG in the treatment of coronary heart disease complicated with thoracic aortic disease is satisfactory in the middle term. If we need to do de-branching operation at the same time to create anchoring area for TEVAR, the operative time and the risk of operation will be increased.
【作者单位】：中国医学科学院北京协和医学院国家心血管病中心阜外医院心血管疾病国家重点实验室血管外科中心;中国医学科学院北京协和医学院国家心血管病中心阜外医院麻醉科;中国医学科学院北京协和医学院国家心血管病中心阜外医院体外循环科;中国医学科学院北京协和医学院国家心血管病中心阜外医院监护室;中国医学科学院北京协和医学院国家心血管病中心阜外医院检验科;
【基金】：中国医学科学院医学与健康科技创新工程(重大协同创新项目)基金资助项目(2016-I2M-1-016) 2017年北京市科技重大专项(D171100002917004)
【分类号】：R654.2

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