冠状动脉旁路移植同期颈动脉内膜剥脱术

目的总结冠心病并发颈动脉狭窄同期手术治疗的经验,并对手术适应证和手术方法进行探讨.方法冠状动脉粥样硬化性心脏病并发颈动脉狭窄11例中,7例先行颈动脉内膜剥脱术(CEA),然后在心脏跳动下行冠状动脉旁路移植术(off-pump CABG);3例先行CEA,然后在体外循环(CPB)下行CABG,其中1例同期二尖瓣成形术,1例在CPR下先行CEA,然后再行CABG.结果术后30d内死亡2例,余9例术后10d内出院,随诊5个月～1年无死亡,复查未发现持续和短暂神经系统症状,无心绞痛和心肌梗死再发生.结论颈动脉内膜剥脱术和冠状动脉旁路移植术可以同期进行,同期手术减少了分期手术间歇期的风险.术中科学规范的外科操作是取得良好效果的关键.

SIMULTANEOUS CAROTID ENDARTERECTOMY AND CORONARY BYPASS GRAFTING

Objective To summarize approach and experience in one - stage surgical management of carotid and cardiac disease. Methods 11 patients underwent simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG). 7 patients underwent CEA at first, then off -pump CABG. The 3 patients underwent CEA at first, then on- pump CABG, one of them concomitant mitral valve plasty. The remain one case were treated under CPB, at first CEA was performed, then CABG. Results 2 patients died in 30 days after operation. The patients being followed up 5-12 months, there were no late death and no gross neurologic complications or myocardial infarction's. Conclusion Combined CABG/CEA may in fact reduce the risk of adverse outcomes in the intermediate term. The described technique is a good method for simultaneous repair of coronary and carotid lesions in patients with concomitant disease.