非体外循环冠状动脉旁路移植术中右冠状动脉完全闭塞率及其治疗策略

目的探讨右冠状动脉完全闭塞率及其在非体外循环冠状动脉旁路移植术（OPCAB）中的治疗策略。方法2005年1月1日至2012年12月31日期间在北京安贞医院行OPCAB患者6206例，从中选取右冠状动脉完全闭塞患者1153例，其中男889例（77．1％）、女264例（22．9％），年龄45～78岁。统计右冠状动脉完全闭塞率，并对右冠状动脉完全闭塞提出治疗建议。结果全组6206例患者中右冠状动脉完全闭塞1153例，闭塞率18．6％。1153例患者均顺利完成手术，术后死亡13例，病死率1．1％。术后发生并发症34例（2．9％），包括脑梗死、少．中量胸腔积液、胸部伤口愈合不良，经相应的治疗均治愈或好转，其余患者均治愈出院。随访1110例，随访率97．4％，失访30例；随访时间1个月至7年。758例心绞痛症状消失，352例心绞痛症状缓解。随访期间586例术前右冠状动脉闭塞患者行冠状动脉64排螺旋CT检查显示桥血管通畅程度良好，且超声心动图和心肌核素扫描检查提示左心室收缩功能及心肌供血获得不同程度的改善。结论本组右冠状动脉完全闭塞率为18．6％，要想获得较好的疗效，需根据患者实际情况选择最适宜的手术术式治疗。

Incidence of Total Occlusion of Right Coronary Artery and Its Treatment Strategy During Off-pump Coronary Artery Bypass Grafting

Objective To explore the incidence of total occlusion of right coronary artery （RCA） and its treatment strategy during off-pump coronary artery bypass grafting （OPCAB）. Methods A total of 1 153 patients with total RCA occlusion were chosen from 6 206 patients who underwent OPCAB in Beijing Anzhen Hospital from January I, 2005 to December 31, 2012. There were 889 male （77.1%） and 264 female （22.9%） patients with their age of 45-78 years. The incidence of total RCA occlusion was calculated, and its treatment strategies were discussed. Results Among 6 206 OPCAB patients, 1 t53 patients （18.6%） had total RCA occlusion. All the 1 153 patients successfully received OPCAB, but 13 patients （1.1%） died postoperatively. Thirty-four patients （2.9%） had postoperative complications including cerebral infarction, mild to moderate pleural effusion and poor wound healing, all of whom were cured or improved, and all the other patients were discharged uneventfully. A total of 1 110 patients （97.4%） were followed up for 1 month to 7 years, and 30 patients were lost during follow-up. Angina symptoms disappeared in 758 patients and were relieved in 352 patients. During follow-up, 64-row helical CT of 586 patients with preoperative total RCA occlusion showed good graft patency, and echocardiography and nuclear myocardial scan showed improved left ventricular systolic function and myocardial blood flow. Conclusion The incidence of total RCA occlusion is 18.6% in our study. Appropriate surgical strategies are needed according to individualized patient conditions to get satisfactory clinical outcomes.