目的：探讨同期颈动脉支架术（CAS）及冠状动脉旁路移植术（CABG）治疗颈动脉狭窄合并冠心病的安全性与疗效。方法：回顾性分析中日友好医院2007年1月―2014年12月收治的25例颈动脉狭窄合并冠心病患者资料，其中11例同期行CAS和CABG（同期组），14例分期行CAS和CABG（分期组），比较两组患者的主要临床指标。结果：两组患者术前基本资料具有可比性。所有患者手术均获成功，无围手术期死亡患者。与分期组比较，同期组中位手术时间（250 min vs. 280 min）、中位住院时间（19 d vs. 24 d）明显缩短（均P<0.05），中位术中出血量（750 mL vs. 600 mL）、输血量（1 000 mL vs. 1 200 mL）、ICU时间（23 h vs. 24 h）、呼吸机时间（19 h vs. 16.5 h）差异均无统计学意义（P>0.05）。同期组出现术后30 d内小卒中1例，一过性脑缺血发作（TIA）1例，围手术期肺部感染1例，术后短暂低血压3例；分期组出现TIA 2例，术后短暂低血压4例，再次开胸止血1例，围手术期肺部感染1例，两组均无心肌梗死及死亡病例。结论：同期和分期行CAS和CABG治疗颈动脉狭窄合并冠心病均安全有效，同期手术可以缩短手术和住院时间，应根据患者的病变特点选择合适的治疗方法。
Efficacy of simultaneous carotid artery stenting and coronary artery bypass grafting for carotid stenosis and concomitant coronary disease
Objective: To evaluate the efficacy of simultaneous carotid artery stenting (CAS) and coronary artery bypass grafting (CABG) in treatment of carotid stenosis and concomitant coronary disease. Methods: The clinical data of 25 patients with carotid stenosis and concomitant coronary disease treated in China-Japan Friendship Hospital from January 2007 to December 2014 were retrospectively analyzed. Of the patients, 11 cases underwent simultaneous CAS and CABG (one-stage group), and 14 cases underwent staged CAS and CABG (two-stage group). The main clinical variables between the two groups of patients were compared. Results: The preoperative general data were comparable between the two groups. In one-stage group compared with two-stage group, the median operative time (250 min vs. 280 min) and median length of hospital stay (19 d vs. 24 d) were significantly reduced (both P<0.05), while the median intraoperative blood loss (750 mL vs. 600 mL), blood infusion (1 000 mL vs. 1 200 mL), length of ICU stay (23 h vs. 24 h) and time on ventilator (19 h vs. 16.5 h) all showed no statistical difference (all P>0.05). Minor stroke within 30 d after operation, transient ischemia attack and perioperative pulmonary infection occurred in one case each and transient postoperative hypotension occurred in 3 cases in one-stage group; TIA occurred in one case, transient postoperative hypotension occurred in 4 cases, re-thoracotomy for hemostasis was required in one case and perioperative pulmonary infection occurred in one case in two-stage group. No myocardial infarction or death occurred in either of the groups. Conclusion: Both simultaneous and staged CAS and CABG are safe and reliable in treatment of carotid stenosis concomitant with coronary disease, and the simultaneous procedure can reduce operative time and hospitalization. However, the appropriate treatment method should be chosen according to the patients’ characteristics.