胸主动脉瘤合并冠心病的外科治疗

目的探讨行胸主动脉瘤置换同期行冠状动脉旁路移植术的安全性及其对预后的影响。方法1982年5月至2004年10月我院收治67例胸主动脉瘤患者,其中同时行冠状动脉旁路移植术者24例：行降主动脉置换+冠状动脉旁路移植术9例,升主动脉置换+冠状动脉旁路移植术15例。将其术后结果与同期仅行胸主动脉置换者进行对比。结果同期行冠状动脉旁路移植术者总病死率为13%(3/24),同期行降主动脉置换+冠状动脉旁路移植术者虽因心肺转流和选择性脑灌注使手术时间显著延长(278±54)与(188±59)min,t=5．397,P＜0．05],但术后并发症发生率、3年生存率和3年无心脏意外率与单纯行胸主动脉置换术者比较,差异无统计学意义(P＞0．05)。结论同期胸主动脉瘤置换+冠状动脉旁路移植术安全可靠,有助于防止因冠心病而致术后远期发生心脏意外。

The clinical study on the surgical treatment of thoracic aortic aneurysm associated with coronary artery disease

OBJECTIVE: To analyze the factors which influence the safety and prognosis of aorta replacement combined with coronary artery bypass grafting (CABG) for thoracic aortic aneurysm associated with coronary artery disease. METHODS: From May 1982 to October 2002, 67 patients with thoracic aortic aneurysm were admitted, and 24 of them combined with CABG. Of the 24 patients, 9 received descending aorta replacement combined with CABG, and the other 15 received the ascending aorta replacement combined with CABG. The treatment results were compared with the other 43 patients only undergoing the thoracic aortic replacement. RESULTS: The mortality rate of the patients with aorta replacement combined with CABG was 13% (3/24). Though the descending aorta replacement combined with CABG could make the cardiopulmonary bypass time and selective cerebral perfusion time longer, (278 +/- 54) min and (188 +/- 59) min respectively, no significant difference was observed in postoperative complications, 3-year survival rate, 3-year-cardiac-event-free rate compared with the patients only undergoing the thoracic aortic replacement (P > 0.05). CONCLUSIONS: The aorta replacement combined with CABG can be performed safely, and the revascularization for coronary artery disease is useful for preventing occurrence of cardiac events.