目的：比较 TAP 技术与改良 mini - Crush（MMC）技术治疗冠状动脉分叉病变的临床效果。方法选取2013年4月—2015年4月绵阳市中心医院收治的冠状动脉分叉病变患者138例，采用随机数字表法分为 TAP 组（A组）70例和 MMC 组（B 组）68例。A 组患者采用 TAP 技术，B 组患者采用 MMC 技术。比较两组患者经皮冠状动脉介入治疗（PCI）成功率，靶病变部位（左主干-前三叉、前降支-对角支、回旋支-钝缘支、右冠状动脉-后三叉）、病变特点（主支病变长度、边支病变长度、主支狭窄程度、边支狭窄程度、分叉角度）、置入支架情况（总支架数量、主支支架长度、边支支架长度）、手术时间、X 线暴露时间、对比剂用量、PCI 相关心肌梗死发生情况、随访12个月主要不良心血管事件（心源性死亡、非致死性心肌梗死、靶血管血运重建）、支架内血栓形成、靶病变（主支、分支）再狭窄发生情况。结果两组患者 PCI 成功率比较，差异无统计学意义（P ﹥0.05）。两组患者靶病变部位、主支病变长度、边支病变长度、主支狭窄程度、边支狭窄程度、分叉角度，总支架数量、主支支架长度、边支支架长度， PCI 相关心肌梗死发生率比较，差异均无统计学意义（P ﹥0.05）；A 组患者手术时间、X 线暴露时间短于 B 组，对比剂用量少于 B 组（P ﹤0.05）。两组患者心源性死亡、非致死性心肌梗死、靶血管血运重建、支架内血栓形成、边支病变再狭窄发生率比较，差异无统计学意义（P ﹥0.05）；A 组患者主支病变再狭窄发生率低于 B 组（P ﹤0.05）。结论TAP 技术治疗冠状动脉分叉病变的临床效果优于 MMC 技术，有利于缩短手术时间和 X 线暴露时间，减少对比剂用量、降低主支病变再狭窄发生率。%Objective To compare the clinical effect on coronary artery bifurcation lesions between T stenting and small protrusion(TAP)technique and modified mini - Crush stenting(MMC) technique. Methods A total of 138 patients with coronary artery bifurcation lesions were selected in the Central Hospital of Mianyang,and they were divided into A group(n= 70 ) and B group( n = 68 ). Patients of A group received TAP technique,while patients of B group received MMC technique. Success rate of PCI,targeted lesions regions( including left main coronary artery - anterior triadius,anterior descending branch - diagonal branch,left circumflex - obtuse marginal branch and right coronary artery - posterior triadius), lesions characteristics(length of main branch lesions and side branch lesions,stenosis grades of main branch lesions and side branch lesions,bifurcation angle),stent implantation related index( total number of implanted stents,stent length of main branch lesions and side branch lesions),duration of operation and X - ray exposure,contrast dosage,incidence of PCI related myocardial infarction,and incidence of major adverse cardiac events( including cardiac death,nonfatal myocardial infarction and targeted vascular reconstruction),intra - stent thrombosis and restenosis of target lesions(including main branch and side branch)during the 12 - month follow - up were compared between the two groups. Results No statistically significant differences of success rate of PCI was found between the two groups( P ﹥ 0. 05 ). No statistically statistically significant differences of length of main branch lesions or side branch lesions,stenosis grades of main branch lesions or side branch lesions, bifurcation angle,total number of implanted stents,stent length of main branch lesions or side branch lesions,or PCI related myocardial infarction was found between the two groups(P ﹥ 0. 05);duration of operation and X - ray exposure of A group was statistically significantly shorter than that of B group,respectively,meanwhile contrast dosage of A group was statistically significantly less than that of B group(P ﹤ 0. 05). No statistically significant differences of incidence of cardiac death,nonfatal myocardial infarction,targeted vascular reconstruction,intra - stent thrombosis or restenosis of side branch was found between the two groups(P ﹥ 0. 05),while incidence of restenosis of main branch of A group was statistically significantly lower than that of B group(P ﹤ 0. 05). Conclusion TAP technique has better clinical effect in treating coronary artery bifurcation lesions than MMC technique,is helpful to shorten the duration of operation and X - ray exposure,reduce the contrast dosage and incidence of restenosis of main branch.
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