择期“分站式”杂交手术治疗多支冠状动脉血管病变早期结果

吴松; 凌云鹏; 傅元豪; 杨航; 郭丽君; 王贵松; 牛杰; 高炜; 万峰

doi:10.13201/j.issn.1001-1439.2016.12.009

择期“分站式”杂交手术治疗多支冠状动脉血管病变早期结果

- 1 北京大学第三医院心脏外科(北京, 100191);
- 2 北京大学第三医院心脏内科

详细信息

通讯作者: 凌云鹏,E-mail:yunpengling@sohu.com

中图分类号: R541.4

收稿日期: 2016-04-16

修回日期: 2016-09-22

Early term outcomes of "2-staged" hybrid coronary revascularization for patients with multivessel coronary artery disease

- 1 Cardiac Surgery Department;
- 2 Cardiology Department, Peking University Third Hospital, BeiJing, 100191, China

More Information

Corresponding author: LING Yunpeng, E-mail: yunpengling@sohu.com

Received Date: 16 April 2016

Revised Date: 22 September 2016

摘要

摘要: 目的:观察择期"分站式"杂交手术治疗冠状动脉(冠脉)多支血管病变的早期结果,评价"分站式"杂交手术的可行性、安全性和疗效。方法:选取因冠脉多支血管病变在我院行择期"分站式"杂交手术的患者73例(HCR组),同时随机选取同期、同一术者完成的非体外循环冠脉搭桥手术患者383例(OPCAB组),进行回顾性研究比较。所有患者术后3个月进行电话问卷随访。结果:HCR组在外科手术时间[(152.9±43.8)min︰(262.6±51.8)min, P＜0.001]、术后总引流量[(558.6±441.3)ml︰(1 035.5±613.3)ml,P＜0.001]、输红细胞[(0.8±1.9)U︰(2.6±4.0)U,P＜0.001]、机械通气时间[(10.5±13.0)h︰(30.5±61.3)h,P=0.006]等指标,明显优于OPCAB组;HCR组处理冠脉支数与OPCAB组没有显著区别[(2.6±0.5)︰(2.7±0.5),P=0.101];HCR组小切口冠脉旁路移植术(MIDCAB)与PCI间隔时间(5.3±2.9)d,冠脉植入支架数(1.6±0.7)。两组患者均无住院期间死亡;术后3个月电话随访,均存活,无再入院,无再发脑梗死、心绞痛再发和心肌梗死。结论:"分站式"杂交手术是一种安全、有效的手术方式,其围手术期和早期随访结果满意,更适合于我国国情,适用于合并LAD严重病变无法接受PCI治疗而RCA或(和)LCX等非LAD病变可以进行PCI治疗的冠脉粥样硬化多支病变者。
- 冠脉血运杂交重建术,"分站式" /
- 经皮冠状动脉介入治疗 /
- 小切口冠状动脉旁路移植术
Abstract: Objective: To compare midterm clinical outcomes of "2-staged" hybrid coronary revascularization (HCR) with off-pump coronary artery bypass grafting (OPCAB) for the treatment of multivessel coronary artery disease. Method: Seventy-three patients who underwent 2-staged HCR because of coronary multivessel lesions were included retrospectively (HCR group).Three hundred and eighty-three other patients who underwent conventional OPCAB by the same surgeon at the same time were selected randomly (OPCAB group). Differences of the clinical data were contrasted between the two groups. Result: The HCR group had less operation duration [(152.9±43.8)min vs (262.6±51.8)min,P＜0.001], bleeding [(558.6±441.3)ml vs (1035.5±613.3)ml,P＜0.001], mechanical ventilation [(10.5±13.0)h vs (30.5±61.3)h, P＜0.006], and blood transfusion [(0.8±1.9)U vs (2.6±4.0)U, P＜0.001]. There was no difference between two groups in the postoperative peak of TNI,serum creatinine and post-operative hospital stays.There was no death during hospitalization in both groups. According to the telephone follow-up of 3 months after surgery,there was no death,readmission,cerebral infarction,myocardial infarction and renal failure in both groups.Conclusion: The 2-staged HCR is safe and feasible for performing the multiple coronary artery revascularization.
- 2-staged hybrid coronary artery revacularization /
- percutaneous coronary intervention /
- minimally invasive direct coronary artery bypass

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