CAJ | 학술논문

目的：总结同期冠状动脉旁路移植术（CABG ）加颈动脉内膜剥脱术（CEA ）治疗冠心病合并颈动脉狭窄的临床经验，探讨手术方法及近中期疗效。方法回顾性分析2008年7月至2013年11月22例冠状动脉狭窄合并严重颈动脉狭窄患者同期行 CABG 与 CEA 手术的临床资料，并且对患者进行术后随访。结果围术期无心肌梗死及脑部并发症发生，1例同时行主动脉瓣、二尖瓣置换术后并发肾功能衰竭死亡，21例痊愈出院。术后随访20例，1例失访，随访率95．2％（20／21），随访12至76个月，平均（44．3±20．2）个月。1例术后3年出现心绞痛，其余患者无心绞痛发作，心功能明显改善；所有患者均无新发脑梗死，16例术前严重头痛、头晕症状明显好转。全部患者术后均经颈动脉超声或颈部血管 CTA 检查显示，颈动脉内膜剥脱加宽部位血流通畅，术后颈动脉血管内径、血流速度、左室射血分数（LEVF）较术前差异有统计学意义（P ＜0．05）。结论同期冠状动脉旁路移植术加颈动脉内膜剥脱术是治疗冠心病合并颈动脉狭窄安全有效的方法。
목적：총결동기관상동맥방로이식술（CABG ）가경동맥내막박탈술（CEA ）치료관심병합병경동맥협착적림상경험，탐토수술방법급근중기료효。방법회고성분석2008년7월지2013년11월22례관상동맥협착합병엄중경동맥협착환자동기행 CABG 여 CEA 수술적림상자료，병차대환자진행술후수방。결과위술기무심기경사급뇌부병발증발생，1례동시행주동맥판、이첨판치환술후병발신공능쇠갈사망，21례전유출원。술후수방20례，1례실방，수방솔95．2％（20／21），수방12지76개월，평균（44．3±20．2）개월。1례술후3년출현심교통，기여환자무심교통발작，심공능명현개선；소유환자균무신발뇌경사，16례술전엄중두통、두훈증상명현호전。전부환자술후균경경동맥초성혹경부혈관 CTA 검사현시，경동맥내막박탈가관부위혈류통창，술후경동맥혈관내경、혈류속도、좌실사혈분수（LEVF）교술전차이유통계학의의（P ＜0．05）。결론동기관상동맥방로이식술가경동맥내막박탈술시치료관심병합병경동맥협착안전유효적방법。
Objective To summarize the clinic experiences of coronary artery bypass grafting (CABG)and carotid endarterectomy (CEA)in the treatment of carotid arteriostenosis and coronary heart diseases,and investigate the opera-tion approaches and curative effects.Methods Clinical data of 22 patients with carotid arteriostenosis complicated with coronary artery diseases who underwent CEA and CABG during July 2008 and Nov 2013 in Qilu Hospital of Shandong University were retrospectively reviewed.Results One patient who underwent double valve replacement due to renal failure died.No cerebral complications were found during the perioperative period.A total of 20 patients (95.2%, 20 /21)were followed up for 12-76 months (mean 44.3 ±20.2 months).Angina occurred in 1 patient three years after operation,while other patients had no symptoms of angina,and their cardiac function were improved significantly.No stroke was found.Of the 16 patients who had severe brain ischemia,the symptoms were remarkably improved after the surgery.Carotid duplex ultrasound or carotid CTA results showed that carotid arteries were widened,and blood flow was smooth.There were statistical differences in blood flow velocity,diameter of vessels and left ventricular ejection fraction (LVEF)before and after operation (P <0.05).Conclusion Concomitant CABG and CEA is safe and effec-tive for patients with carotid arteriostenosis and coronary artery diseases.