【摘要】 目的评价同期行颈动脉内膜剥脱术(CEA)联合冠状动脉搭桥术(CABG)治疗颈动脉与冠状动脉狭窄并存疾病的安全性和临床疗效。方法总结2000年1月至2013年8月我科收治的34例并存颈动脉与冠状动脉狭窄并均实施了同期CEA联合CABG手术患者的临床资料,其中男21例,女13例;年龄54~85岁,平均(70±6)岁。所有患者术前均行冠状动脉和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17例,2支血管病变11例。先行CEA再行CABG者33例,1例先行CABG再行CEA。Off-Pump CABG 26例,On-Pump 8例。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加宽颈动脉切口。结果无手术死亡病例,无围术期心肌梗死、脑血管意外。1例于术后1个月因下肢动脉硬化闭塞症行右侧股-腘动脉人工血管搭桥术。术后随访6~84个月,无心脑血管事件发生。结论同期行CEA联合CABG处理颈动脉与冠状动脉狭窄并存疾病安全、有效,可有效预防围术期心脑血管并发症的发生,中期随访效果满意。更多还原

【Abstract】 Objective To evaluate clinical safety and efficiency of simultaneous carotid endarterectomy( CEA) and coronary artery bypass grafting( CABG) on patients with combined carotid and coronary artery stenosis.Methods From January 2000 to August 2013,34 patients[21males,13 females,aged( 70 ± 6) years in average]underwent combined CEA and CABG in our department. Preoperative coronary and carotid artery angiography revealed that left main trunk stenosis occurred in 6 cases,triple-vessel disease in 17 cases,double-vessel disease in11 cases. 33 patients were given unilateral CEA firstly and then CABG. Only 1 case was given CABG firstly and then unilateral CEA. 26 cases received Off-Pump CABG and 8 cases underwent CABG with cardiopulmonary bypass support. An intraluminal carotid shunt and patch repair were used in all CEA procedure. Results There were no operative mortality and perioperative cardio-cerebral vascular accidents in our study. 1 case received right femopopliteal artificial graft bypass for lower extremity atherosclerotic occlusive disease 1 month after the simultaneous CEA and CABG. No cardiovascular events were observed during the 6 to 84-month follow-up. Conclusions Simultaneous CEA and CABG is effective and safety for patients combined carotid and coronary artery severe stenosis. It can effectively prevent postoperative cardio-cerebral vascular complications with satisfactory mid-term result.更多还原