CAJ | 학술논문

目的探讨冠状动脉旁路移植术(CABG)和颈动脉内膜剥脱术(CEA)治疗冠心病合并颈动脉狭窄的治疗方法的选择.方法 2009年1月至2011年12月期间,首都医科大学附属北京安贞医院大血管中心23例冠心病合并颈动脉狭窄患者同期或分期行CABG和CEA治疗,男16例,女7例.年龄53 ～ 82岁,平均(65.9±4.0)岁.冠状动脉造影发现左主干病变3例,2支病变3例,3支病变17例.1例合并二尖瓣关闭不全.单侧颈动脉狭窄17例,双侧狭窄6例,直径狭窄≥70％.依据患者两处病变病情严重程度而采取冠状动脉旁路移植术(CABG)和颈动脉内膜剥脱术(CEA)同期或分期治疗,术后观察围手术期发生卒中、心肌梗死的及死亡情况,并随访.结果 7例患者同期行CEA和CABG,其中1例同时行二尖瓣置换；13例患者先期行CABG后行CEA;3例患者先行CEA后行CABG.围术期死亡1例(4.3％),无心绞痛、心肌梗死和卒中.随访6个月,随访期内患者未发生死亡、卒中、心绞痛及心肌梗死.结论同期还是分期行CABG和CEA治疗冠心病合并颈动脉狭窄应根据患者具体情况而定,个性化治疗是降低手术风险的关键.
목적 탐토관상동맥방로이식술(CABG)화경동맥내막박탈술(CEA)치료관심병합병경동맥협착적치료방법적선택.방법 2009년1월지2011년12월기간,수도의과대학부속북경안정의원대혈관중심23례관심병합병경동맥협착환자동기혹분기행CABG화CEA치료,남16례,녀7례.년령53 ～ 82세,평균(65.9±4.0)세.관상동맥조영발현좌주간병변3례,2지병변3례,3지병변17례.1례합병이첨판관폐불전.단측경동맥협착17례,쌍측협착6례,직경협착≥70％.의거환자량처병변병정엄중정도이채취관상동맥방로이식술(CABG)화경동맥내막박탈술(CEA)동기혹분기치료,술후관찰위수술기발생졸중、심기경사적급사망정황,병수방.결과 7례환자동기행CEA화CABG,기중1례동시행이첨판치환；13례환자선기행CABG후행CEA;3례환자선행CEA후행CABG.위술기사망1례(4.3％),무심교통、심기경사화졸중.수방6개월,수방기내환자미발생사망、졸중、심교통급심기경사.결론 동기환시분기행CABG화CEA치료관심병합병경동맥협착응근거환자구체정황이정,개성화치료시강저수술풍험적관건.
Objective To investigate how to combine carotid endarterectomy (CEA) and coronary artery bypass grafting(CABG) on patients with carotid arteriostenosis and coronary heart diseases.Methods Total of 23 consecutive patients with carotid artery stenosis and coronary artery diseases underwent CEA and CABG between January 2009 and December 2011 in Beijing Aortic Center Beijing Anzhen Hospital of Capital Medical University.There were 16 males and 7 females,with their ages ranged from 53 to 82 years[(65.9 ±4.0) years].20 patients had at least 3-vessel coronary artery lesions,and there were 3 cases of left main,and one with mitral valve insufficiency.At least 70％ stenosis occurred in 17 patients with unilateral carotid arteriostenosis,and in 6 patients with bilateral lesion.After assessing and comparing the severity extent of coronary artery lesion and coronary artery lesion,synchronous or staged CEA and CABG was performed accordingly.The occurrence of stroke,myocardial infarction,and death after operation was observed,and follow-up was carried out in 6 months.Results 7 patients underwent synchronous CEA and CABG (one plus mitral valve replacement) ; 13 underwent CABG then CEA; 3 underwent CEA then CABG.Perioperative death occurred in one patient.None of the patients had stroke or myocardial infarction.During the follow-up period,none of the patients manifested stroke,myocardial infarction or death.Conclusion Therapeutic strategy (synchronous or staged CABG and CEA) should not be fixed unified but be selected in accordance with the specific circumstance of a patient.Individual treatment is the key to reduce the surgical risk.