胸降主动脉夹层合并冠心病患者行主动脉腔内隔绝术联合PCI的疗效

摘要

Objective: To evaluate therapeutic effect of aortic endovascular stent-graft exclusion (EVGE) combined percutaneous coronary intervention (PCI) on patients with descending thoracic aortic dissection (DTAD) complicated coronary heart disease (CHD).Methods: A total of 58 DTAD + CHD patients undergoing aortic EVGE combined PCI were regarded as EVGE group (received aortic EVGE at first, then PCI on 3d after operation).Another 60 DTAD+CHD patients undergoing open surgery combined PCI in our hospital were selected as open surgery group.Both groups were observed and followed up, and their therapeutic effects were compared.Results: Compared with open surgery group, there was significant rise in complete cut closure rate (78.33% vs.91.38%), and significant reductions in bleeding volume during operation [(919.83±242.12) ml vs.(58.17±9.53) ml], postoperative infection rate (15.0% vs.3.4%) and hospital stay [(16.40±0.96)d vs.(9.10±0.83)d] in EVGE group, P<0.05 or <0.01.Success rate of PCI was 100% in EVGE group, and there was no PCI-related severe complications.During follow-up, coronary restenosis rate within 12 months in EVGE group was significantly lower than that of open surgery group (5.20% vs.15.30%, P=0.04).Conclusion:It is safe and possesses significant effective to treat descending thoracic aortic dissection complicated coronary heart disease using aortic endovascular stent-graft exclusion combined percutaneous coronary intervention, which is worth extending.%目的:评价胸降主动脉夹层合并冠心病患者行主动脉腔内隔绝术联合经皮冠状动脉介入治疗(PCI)的疗效.方法:选择58例主动脉腔内隔绝术联合PCI治疗的胸降主动脉夹层合并冠心病患者为隔绝术组(先进行主动脉腔内隔绝术,术后3d接受PCI 治疗),另选择60例在本院行开放性手术联合PCI治疗的胸降主动脉夹层合并冠心病患者为开放性手术组,观察并随访比较二者的疗效.结果:与开放性手术组比较,隔绝术组破口完全封堵率明显提高(78.33%比91.38%),术中出血量[(919.83±242.12) ml比(58.17±9.53) ml]、术后感染率(15.0%比3.4%)和住院时间[(16.40±0.96)d比(9.10±0.83)d]均明显减少(P<0.05或<0.01).隔绝术组PCI 成功率为100%,无PCI 相关严重并发症发生.随访期内,隔绝术组12个月内冠脉再狭窄率明显低于开放性手术组(5.20%比15.30%,P=0.04).结论:主动脉腔内隔绝术联合PCI 治疗胸降主动脉夹层合并冠心病疗效显著,安全,值得临床推广.