专题研究(Monographic Study)

“一站式”腔内治疗冠心病合并主动脉粥样硬化性疾病的探讨

Published at: 2016年第25卷第12期

罗明尧 1 , 唐熠达 1 , 方坤 1 , 陈祖君 1 , 陈雷 1 , 吕滨 1 , 常谦 1 , 孙晓刚 1 , 欧阳晨曦 1 , 舒畅 1,2
1 中国医学科学院 北京协和医学院 国家心血管病中心;阜外医院 心血管疾病国家重点实验室,北京 100037
2 中南大学湘雅二医院 血管外科,湖南 长沙 410011
通讯作者 畅 舒 Email: changshu01@yahoo.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2016.12.003
基金:
中国医学科学院医学与健康科技创新工程(重大协同创新项目)基金资助项目 2016-I2M-1-016

摘要

目的:探讨冠状动脉介入治疗(PCI)联合主动脉腔内修复术(EVAR)“一站式”治疗冠心病和主动脉粥样硬化性疾病的临床策略及其安全性。方法:回顾性分析2016年1月—2016年6月中国医学科学院阜外医院行腔内治疗的7例合并冠心病的主动脉粥样硬化性疾病患者资料,其中男6例,女1例,平均年龄76.2(64~86)岁,术前主动脉CT和冠脉CT确诊主动脉病变和冠脉病变并存,术中造影确认主动脉和冠脉病变均符合介入治疗指征后,实施“一站式”手术治疗。结果:手术成功率100%,无围术期死亡。术后并发症包括切口附近皮下瘀斑2例,其中合并血肿1例,后者因血色素下降予以输注浓缩红细胞2 U治疗。1例主动脉弓降部溃疡患者以烟囱技术重建左锁骨下动脉,其左侧肱动脉穿刺点出现假性动脉瘤,予以外科修复。所有患者均获得门诊或电话随访,随访时间7(6~10)个月,所有患者临床症状消失或明显减轻,生活质量改善,无再次手术或死亡。结论:PCI联合EVAR“一站式”治疗冠心病和主动脉粥样硬化性疾病早中期疗效满意,切口或穿刺部位出血性并发症应予警惕。术后药物治疗方案严格按照冠心病的治疗原则进行。


"One-stop" endovascular treatment for concomitant coronary heart disease and aortic atherosclerotic disease

Abstract

Objective: To investigate the clinical strategies and safety of “one-stop" solution by combination of percutaneous coronary intervention (PCI) endovascular aortic repair (EVAR) for concomitant coronary heart disease and aortic atherosclerotic disease. Methods: The clinical data of 7 patients with aortic atherosclerotic disease and concomitant coronary heart disease undergoing endovascular treatment in Fuwai Hospital from January 2016 to June 2016 were retrospectively analyzed. Of the patients, 6 cases were male and 1 case was female, with an average of 76.2 (64–86) years of age; the co-existence of aortic atherosclerotic disease and coronary heart disease was confirmed by preoperative aortic and coronary CT imaging, and all underwent “one-stop” operation after verification of indications for interventional therapy in both aortic and coronary artery lesions by intraoperative angiography. Results: The operative success rate was 100% and no perioperative death occurred. Postoperative complications included subcutaneous ecchymosis near the incision site in 2 cases, of whom, 1 case complicated with hematoma and given transfusion received 2 U packed red blood cells due to hemoglobin decline. One case with descending aortic arch ulcer undergoing reconstruction of the left subclavian artery by chimney technique, developed pseudoaneurysm at the puncture site of the left brachial artery, and then underwent surgical repair. All patients were followed up by outpatient visit or telephone contact, and during the follow-up period of 7 (6–10) months, their symptoms had disappeared or were significantly alleviated, with improved quality of life; no repeat operation was required and no death occurred. Conclusion: “One-stop” treatment by PCI and EVAR for concomitant coronary heart disease and aortic atherosclerotic disease has satisfactory short- and mid-term efficacy, and precaution should be taken for the hemorrhagic complications in the incision and puncture site. Postoperative medications should be strictly given according to the principle for coronary heart disease treatment.


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引用

引用本文: 明尧 罗, 熠达 唐, 坤 方, 祖君 陈, 雷 陈, 滨 吕, 谦 常, 晓刚 孙, 晨曦 欧阳, 畅 舒. “一站式”腔内治疗冠心病合并主动脉粥样硬化性疾病的探讨 [J]. 中国普通外科杂志, 2016, 25(12): 1683-1688.
Cite this article as: LUO Mingyao, TANG Yida, FANG Kun, CHEN Zujun, CHEN Lei, LU Bin, CHANG Qian, SUN Xiaogang, OUYANG Chenxi, SHU Chang . "One-stop" endovascular treatment for concomitant coronary heart disease and aortic atherosclerotic disease[J]. Chin J Gen Surg, 2016, 25(12): 1683-1688.