联合冠状动脉血运重建术国内首例报告(摘要)
作者：
单位：刘海波 高润霖 杨跃进 姚 民 徐 波 秦学文 陈纪林 北京市，中国医学科学院 中国协和医科大学 阜外心血管病医院 心血管病研究所； 北京市，中国医学科学院 中国协和医科大学 冠心病研究室(100037) 心血管病研究所； 外科 胡盛寿(第三作者) 宋云虎(第六作者) 麻醉科 刘 进
关键词：
中国循环杂志99zk20 目的：为冠心病某些多支病变的患者寻找一条安全、有效、恢复快的血运重建治疗途径。
方法与结果：一位60岁的男性冠心病患者，大剂量抗心肌缺血药物不能控制心绞痛发作。冠状动脉造影显示：前降支中段100%闭塞，回旋支近段95%狭窄，右冠状动脉近段40%～50%狭窄。其中前降支病变不仅闭塞时间较长，而且闭塞处形态均提示不宜行经皮冠状动脉腔内成形术(PTCA)及支架置入术，而较适合外科冠状动脉旁路移植术(CABG)。另一支病变血管回旋支，狭窄以远分成4支较小的边缘支，若行CABG术，需搭四支“桥”，且效果不会满意，而较适合于内科的PTCA及支架置入术。以上情况提示，对该例患者，无论内科还是外科，单方面治疗的效果将不满意。经内外科详细讨论后，决定行联合冠状动脉血运重建术(ICR)。于1999年5月11日先在导管室进行回旋支PTCA及支架置入术，随后送外科手术室通过左胸前区微创小切口采用乳内动脉直接进行前降支CABG术(MIDCAB)。数天后，患者很快恢复出院。术后3个月冠状动脉造影复查显示：前降支的内乳动脉桥及回旋支的支架置入处血管通畅，无再狭窄。
, 百拇医药
结论：所谓联合冠状动脉血运重建术(ICR)，是国外近年来发展起来的、由内科及外科结合起来治疗冠心病多支冠状动脉病变的一种创伤小、恢复快及疗效好的方法。具体地说，就是由心外科医师在心脏不停跳的情况下，于左胸前区作一微创小切口对靠近胸前壁的一支有病的冠状动脉(即前降支)采用乳内动脉直接进行CABG术(即MIDCAB)。而由心内科医师采用血管内导管技术对另两支离胸前壁较远的病变冠状动脉的一支或两支(即右冠状动脉或回旋支)进行PTCA或支架置入术。我院内、外科合作对该例患者进行ICR术成功，不仅创伤小、恢复快，且效果满意。这也是我国首例ICR术。
Combined Percutaneous Transluminal Angioplasty and Minimally Invasive Direct Coronary Artery Bypass in Patient with Multivessel Coronary Artery Disease: The First Case Report in China (Abstract)
, 百拇医药
Division of Coronary Heart Disease, Cardiovascular Institute
and Fu Wai Hospital, CAMS and PUMC, Beijing (100037)
Liu Haibo, Gao Runlin, Hu Shengshou, et al.
Objective: To test a new optimal revascularization alternative to deal with some patients with multivessel coronary heart disease.
Methods and Results: The patient was a 60 year-old male who was admitted to our hospital in April 20, 1999, with a chief complaint of chest pain for 3 years and was diagnosed with “Coronary heart disease: Effort angina pectoris”. During in-hospital course, he was treated with high doses of atenolol, diltiazem and nitrates, but his chest pain was not ideally controlled. Coronary angiogram showed: 100% occlusion at the middle of LAD, 95% stenosis at the proximal LCX and 40%～50% stenosis at the proximal RCA. LAD lesion was thought to have been occluded for more than 3 months and less than ideal for percutaneous transluminal angioplasty (PTCA), and LCX was complicated by several relatively small marginal branches developed after stenosis and was thought not to be an indication for coronary bypass grafting (CABG). On May 11, 1999, the patient was firstly sent to the Catheterization laboratory to receive PTCA and stent implantation in his LCX lesion, and then he was transferred to the operating room to undergo minimally invasive direct coronary artery bypass (MIDCAB) in his LAD lesion. The whole procedure appeared very successful. Following the procedure, his chest pain disappeared and the patient was discharged from our hospital a few days later. Coronary angiography at 3 months follow-up revealed patency of LIMA anastomosis and the site treated with stent.
, 百拇医药
Conclusions: Recently, minimally invasive direct coronary artery bypass (MIDCAB) to the LAD through a small left anterior thoracotomy using the left internal mammary artery has been performed with excellent early results compared with standard bypass surgery. However, the MIDCAB operation is currently limited to revascularization of the LAD territory, with the circumflex and the right coronary arteries less accessible, making this surgical approach inappropriate for providing complete revascularization in patients with multivessel disease. An important treatment alternative called integrated coronary revascularization (ICR) was developed to deal with these patients: MIDCAB to the LAD combined with PTCA (or stenting) of the other diseased vessels, and the early results turned to be encouraging. ICR was performed successfully in our present case with no postoperative complications. We believe that ICR is a safe and effective therapy for some patients with multivessel coronary artery disease., 百拇医药
单位：刘海波 高润霖 杨跃进 姚 民 徐 波 秦学文 陈纪林 北京市，中国医学科学院 中国协和医科大学 阜外心血管病医院 心血管病研究所； 北京市，中国医学科学院 中国协和医科大学 冠心病研究室(100037) 心血管病研究所； 外科 胡盛寿(第三作者) 宋云虎(第六作者) 麻醉科 刘 进
关键词：
中国循环杂志99zk20 目的：为冠心病某些多支病变的患者寻找一条安全、有效、恢复快的血运重建治疗途径。
方法与结果：一位60岁的男性冠心病患者，大剂量抗心肌缺血药物不能控制心绞痛发作。冠状动脉造影显示：前降支中段100%闭塞，回旋支近段95%狭窄，右冠状动脉近段40%～50%狭窄。其中前降支病变不仅闭塞时间较长，而且闭塞处形态均提示不宜行经皮冠状动脉腔内成形术(PTCA)及支架置入术，而较适合外科冠状动脉旁路移植术(CABG)。另一支病变血管回旋支，狭窄以远分成4支较小的边缘支，若行CABG术，需搭四支“桥”，且效果不会满意，而较适合于内科的PTCA及支架置入术。以上情况提示，对该例患者，无论内科还是外科，单方面治疗的效果将不满意。经内外科详细讨论后，决定行联合冠状动脉血运重建术(ICR)。于1999年5月11日先在导管室进行回旋支PTCA及支架置入术，随后送外科手术室通过左胸前区微创小切口采用乳内动脉直接进行前降支CABG术(MIDCAB)。数天后，患者很快恢复出院。术后3个月冠状动脉造影复查显示：前降支的内乳动脉桥及回旋支的支架置入处血管通畅，无再狭窄。
, 百拇医药
结论：所谓联合冠状动脉血运重建术(ICR)，是国外近年来发展起来的、由内科及外科结合起来治疗冠心病多支冠状动脉病变的一种创伤小、恢复快及疗效好的方法。具体地说，就是由心外科医师在心脏不停跳的情况下，于左胸前区作一微创小切口对靠近胸前壁的一支有病的冠状动脉(即前降支)采用乳内动脉直接进行CABG术(即MIDCAB)。而由心内科医师采用血管内导管技术对另两支离胸前壁较远的病变冠状动脉的一支或两支(即右冠状动脉或回旋支)进行PTCA或支架置入术。我院内、外科合作对该例患者进行ICR术成功，不仅创伤小、恢复快，且效果满意。这也是我国首例ICR术。
Combined Percutaneous Transluminal Angioplasty and Minimally Invasive Direct Coronary Artery Bypass in Patient with Multivessel Coronary Artery Disease: The First Case Report in China (Abstract)
, 百拇医药
Division of Coronary Heart Disease, Cardiovascular Institute
and Fu Wai Hospital, CAMS and PUMC, Beijing (100037)
Liu Haibo, Gao Runlin, Hu Shengshou, et al.
Objective: To test a new optimal revascularization alternative to deal with some patients with multivessel coronary heart disease.
Methods and Results: The patient was a 60 year-old male who was admitted to our hospital in April 20, 1999, with a chief complaint of chest pain for 3 years and was diagnosed with “Coronary heart disease: Effort angina pectoris”. During in-hospital course, he was treated with high doses of atenolol, diltiazem and nitrates, but his chest pain was not ideally controlled. Coronary angiogram showed: 100% occlusion at the middle of LAD, 95% stenosis at the proximal LCX and 40%～50% stenosis at the proximal RCA. LAD lesion was thought to have been occluded for more than 3 months and less than ideal for percutaneous transluminal angioplasty (PTCA), and LCX was complicated by several relatively small marginal branches developed after stenosis and was thought not to be an indication for coronary bypass grafting (CABG). On May 11, 1999, the patient was firstly sent to the Catheterization laboratory to receive PTCA and stent implantation in his LCX lesion, and then he was transferred to the operating room to undergo minimally invasive direct coronary artery bypass (MIDCAB) in his LAD lesion. The whole procedure appeared very successful. Following the procedure, his chest pain disappeared and the patient was discharged from our hospital a few days later. Coronary angiography at 3 months follow-up revealed patency of LIMA anastomosis and the site treated with stent.
, 百拇医药
Conclusions: Recently, minimally invasive direct coronary artery bypass (MIDCAB) to the LAD through a small left anterior thoracotomy using the left internal mammary artery has been performed with excellent early results compared with standard bypass surgery. However, the MIDCAB operation is currently limited to revascularization of the LAD territory, with the circumflex and the right coronary arteries less accessible, making this surgical approach inappropriate for providing complete revascularization in patients with multivessel disease. An important treatment alternative called integrated coronary revascularization (ICR) was developed to deal with these patients: MIDCAB to the LAD combined with PTCA (or stenting) of the other diseased vessels, and the early results turned to be encouraging. ICR was performed successfully in our present case with no postoperative complications. We believe that ICR is a safe and effective therapy for some patients with multivessel coronary artery disease., 百拇医药