|
激光心肌血管重建加冠状动脉旁路术在冠心病治疗中的应用 |
| |
万峰 江龙 杨碧波 芮志良 刘晓飞 王升声 高峰
【摘要】 目的 回顾应用激光心肌血管重建术（transmyocardial laser revascularization，TMLR）加冠状动脉旁路术（coronary artery bypass grafting，CABG）联合手术治疗冠心病的早期效果和经验。方法 50例病人皆为冠心病冠状动脉造影三支病变（男性43例，女性7例），平均年龄55岁（36～74岁），其中15例左室射血分数小于30%，80%病人的心绞痛CCS分级为Ⅲ～Ⅳ级。4例行左前外小切口非体外循环跳动心脏手术，其它为常规正中开胸低温体外循环下行CABG+TMLR术,90%的病人使用了乳内动脉。术后14例病人需要主动脉球囊反搏（IABP）辅助循环。TMLR使用钬激光机（美国Eclipse TMR System 2000型，20W）。平均每例搭桥3.8根,激光打孔35个。结果 一年中完成50例手术，获得了良好的临床效果,无一例死亡，术后不仅明显缓解心绞痛症状，而且能改善了心功能。结论 本组病人近期良好的临床效果表明，CABG+TMLR是一种安全、有效的治疗冠心病的方法，特别适用于重症、弥漫、远端病变及严重心功受损病人。
【关键词】 血管成形术，激光 胸廓内动脉-冠状动脉吻合术 冠状动脉疾病
Clinical application of combined TMLR with CABG to treat coronary artery disease
Wan Feng, Jiang Long, Yang Bibo, et al. Cardiothoracic Surgery, Post-telecom &127;General Hospital, Beijing 100032
【Abstract】 Objective To retrospectively review the experience and the early clinical results of a new surgical technique for the treatment of coronary artery disease(CAD). Methods From July of 1996 to July of 1997, we have performed combined coronary artery bypass grafting (CABG) with transmyocardial laser revascularization (TMLR) on 50 patients (male 43, female 7 )with tri-vessel diseae,aged from 36-74 years with a mean of 55. Left ventricular ejection fraction of 15 patients were lower than 30%. Eighty percent patients had class III or IV preoperative angina. Four patients were operated upon a beating heart with mini-left anterior thoracotomy without CPB (Cardiopulmonary bypass). For TMLR the holium YAG laser machine (20W) was used. The mean number of grafts was 3.8, the average number of laser created channels was 35. Internal mammary artery (IMA) was used in 90% of patients. Post operative intraaortic balloon pump (1ABP) support was required in 14 cases. Results Postoperative mortality was 0/50, all patients were still alive at a mean follow-up period of 6 months with 17 being angina free and 19 in class I angina. Conclusion The good sho[1] [2] 下一页
上一个医学论文： 小剂量多巴酚丁胺及其合用硝酸酯超声心动图试验识别冬眠心肌的对比研究
下一个医学论文： 补救性经皮冠状动脉腔内成形术治疗急性心肌梗塞
|
|
|
|
|
|
|
您现在的位置： 绿色健康网 >> 医学论文 >> 内科论文 >> 正文