CAJ | 학술논문

目的探讨同期冠状动脉旁路移植术(CABG)联合颈动脉内膜切除术(CEA)治疗冠状动脉重度狭窄合并颈动脉重度狭窄的安全性和临床疗效. 方法总结2001年1月至2012年9月我科施行的CABG和CEA同期手术31例患者的临床资料,其中男19例、女12例,年龄54～80岁,平均(67±12)岁.患者术前经选择性冠状动脉和双侧颈动脉造影明确诊断,其中冠状动脉左主干病变6例,3支血管病变15例,2支血管病变10例.术式先行CEA再行CABG者30例,1例患者先行CABG再行CEA.CABG于非体外循环下施行者24例,7例于体外循环下施行.CEA全部为单侧,术中均使用颈动脉转流管,并采用人工血管补片成形颈动脉切口. 结果本组无手术死亡病例,无围术期心肌梗死、脑血管意外.1例患者于术后1个月因下肢动脉硬化闭塞症行右侧股-腘动脉人工血管旁路移植.术后随访6～84个月,本组中无心脑血管事件发生. 结论 CABG联合CEA处理冠状动脉合并颈动脉重度狭窄安全、有效,可有效预防围术期心脑血管并发症发生,中期随访效果满意.
목적 탐토동기관상동맥방로이식술(CABG)연합경동맥내막절제술(CEA)치료관상동맥중도협착합병경동맥중도협착적안전성화림상료효. 방법 총결2001년1월지2012년9월아과시행적CABG화CEA동기수술31례환자적림상자료,기중남19례、녀12례,년령54～80세,평균(67±12)세.환자술전경선택성관상동맥화쌍측경동맥조영명학진단,기중관상동맥좌주간병변6례,3지혈관병변15례,2지혈관병변10례.술식선행CEA재행CABG자30례,1례환자선행CABG재행CEA.CABG우비체외순배하시행자24례,7례우체외순배하시행.CEA전부위단측,술중균사용경동맥전류관,병채용인공혈관보편성형경동맥절구. 결과 본조무수술사망병례,무위술기심기경사、뇌혈관의외.1례환자우술후1개월인하지동맥경화폐새증행우측고-객동맥인공혈관방로이식.술후수방6～84개월,본조중무심뇌혈관사건발생. 결론 CABG연합CEA처리관상동맥합병경동맥중도협착안전、유효,가유효예방위술기심뇌혈관병발증발생,중기수방효과만의.
Objective To evaluate clinical safety and efficacy of simultaneous coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) in patients with combined coronary and carotid artery severe stenosis.Methods From January 2000 to September 2012,31 patients [19 males,12 females,aged (67± 12) years in average] underwent combined CABG and CEA in our hospital.Preoperative coronary and carotid artery angiography revealed that left main trunk stenosis occurred in 6 cases,triple-vessel disease in 15 cases,double-vessel disease in 10 cases.30 patients were given unilateral CEA firstly and then CABG.Only 1 case was given CABG firstly and then unilateral CEA.24 cases underwent CABG without cardiopulmonary bypass (CPB),and 7 cases underwent CABG with CPB.An intraluminal coronary shunt tube and patch repair were used in CEA procedure.Results There were no operative mortality and perioperative cardio-cerebral vascular accidents in this study.1 case received right femo-popliteal artificial graft bypass for lower extremity atherosclerotic occlusive disease 1 month after the simultaneous CABG and CEA.No cardiovascular events were observed during the 6-84-month follows-up period.Conclusions The simultaneous CABG and CEA is an effective and safe treatment for combined coronary and carotid artery severe stenosis.It can effectively prevent postoperative cardio-cerebral vascular complications with satisfactory mid-term follow-up result.