摘要
目的探讨非体外循环冠状动脉旁路移植术（OPCAB）治疗冠状动脉慢性完全闭塞病变（CTO）的可行性，总结其临床经验。方法1999年8月～2007年10月我院共收治696例CTO患者，共853支冠状动脉完全闭塞（其中冠状动脉造影显示显示无逆显影127支、有逆显影726支），均行OPCAB（术前冠状动脉造影显示无逆显影的CTO患者中术中有26支有血流，而有逆显影的CTO患者中有63支无血流），共移植血管桥2231支。其中施行内膜剥脱术（CE）后行冠状动脉旁路移植术（CABG）136支，行心中静脉原位静脉动脉化28支。术中有15例因血流动力学不稳定改为体外循环下CABG，其中6例安放主动脉内球囊反搏（IABP）。结果术中无死亡患者；术后住院期间死亡6例，其中2例死于严重低心排血量，2例死于肾功能衰竭，1例死于围术期心肌梗死，1例死于脑血管意外。术后发生应激性溃疡1例，纵隔感染1例，均经对症治疗后痊愈。术后随访1个月～9年，随访686例（99．42％），失访4例；心绞痛缓解率99．85％（685／686），心功能分级（NYHA）Ⅰ～Ⅱ级。结论CTO患者应用OPCAB可以取得良好的治疗效果，手术死亡率及并发症明显降低。冠状动脉造影对评价冠状动脉完全闭塞有一定的局限性，冠状动脉血管内视镜技术和血管内超声心动图可以协助诊断。
Objective To investigate the surgical therapy for chronic total occlusion （CTO） of coronary artery with off-pump coronary artery bypass grafting （OPCAB）. Methods From Aug. 1999 to Oct. 2007, 696 patients with 853 totally occluded coronary arteries （127 coronary arteries lack of opacification while the other 726 arteries with reverse flow showed by coronary angiography） underwent OPCAB. A total of 2 231 grafts were constructed including 136 placed to coronary endarterectomy （CE） targets and 28 arterialized middle cardiac veins. Blood flow was detected during operation in 26 coronary arteries with no opaeification in preoperative angiography, while no blood flow was detected in 63 coronary arteries with opacification in preoperative angiography. Cardiopulmonary bypass was applied in 15 cases because of a poor hemodynamics and 6 of which were assisted with intra-aortic balloon pump（IABP）. Results All patients survived the operation. 6 died in hospital because of low cardiac output （2 cases）, renal failure （2 cases）, perioperative cardiac infarction （1 case） or eerebrovascular accident （1 case）. Stress ulceration occurred in one case, mediastinal infection occurred in another case after operation. Both were treated medically and recovered. 692 patients were followed up and the rate of flup was 99. 42G（685/686）, with 4 withdrawal. Freedom from cardiac angina was 99.85%（685/686） and cardiac functional grading （NYHA） was Ⅰ-Ⅱ . Conclusion OPCAB can he well performed in patients with chronic total occlusion of coronary arteries. The ralue of coronary angiography for evaluating totally occluded coronary artery is limited, and endoscope or intravascular ultrasound techniques may he helpful.
出处
《中国胸心血管外科临床杂志》
CAS
2008年第6期411-414,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
辽宁省科技厅重大攻关资助项目(2006401013-2)~~
关键词
冠状动脉慢性完全闭塞
体外循环
非体外循环冠状动脉旁路移植术
Chronic total occlusion of coronary artery
Extracorporeal circulation
Off-pump coronaryartery bypass grafting
