目的:评价冠心病合并颈动脉狭窄患者同期行非体外循环冠状动脉旁路移植术(OPCABG)和颈动脉内膜剥脱术(CEA)的临床安全性及有效性.方法:收集2002年8月至2015年8月,于我院同期行冠状动脉旁路移植术和颈动脉内膜剥脱术患者的资料,共计44例,男性36例,女性8例,年龄37 ～ 75岁,平均年龄(64±8)岁.42例不稳定性心绞痛,2例心肌梗死.32例合并高血压,16例合并糖尿病,4例并发陈旧性心肌梗死,1例合并陈旧性脑梗死病史.冠状动脉造影显示:4例2支病变,40例3支病变.颈动脉超声提示:27例双侧病变,17例单侧严重变,术中均先行CEA再行OPCABG.结果:手术患者术后住院期间死亡1例,为术后心肌梗死;1例患者术后住院期间发生短暂性脑缺血发作;1例于术后1年内死亡,死亡原因不明;2例术后1年内再次行CEA,均为双侧重度狭窄患者;2例术后随访1～2年内发生脑梗死.余39例术后随访时间6个月～6年,复查无神经系统事件及心肌梗死事件.结论:同期行OPCABG和CEA治疗冠心病合并颈动脉狭窄疾病安全、有效,近期及中期随访效果良好.%Objective:This article's aim is to evaluate clinical safety and efficiency of simultaneous off-pump coronary artery bypass graft surgery (OPCABG) and carotid endarterectomy (CEA) on patients with coronary heart disease and carotid artery stenosis.Methods:We collected 44 cases [36 males,8females,aged (64 ± 8) years in average] witch underwent simultaneous OPCABG and CEA from August 2002 to August 2015.42 patients had unstable angina,2 patients had myocardial infarction.32 cases were with hypertension,16 were with diabetes mellitus,4 cases had myocardial infarction previously,1 had cerebral infarction previously.Coronary angiography revealed that triple-vessel disease in 40 patients,double-vessel disease in 4 patients.Carotid artery ultrasound revealed that bilateral lesions in 27 cases,unilateral lesions in 17 cases.Results:There was one patient dead in hospital after surgery for the postsurgical myocardial infarction,one took transient cerebral ischemic attack(TIA).1 patient dead in one year later,2 patients underwent CEA on the other cerebral artery again.2cases took cerebral infarction during 2 years after surgery.The rest of 39 cases didn't occur cardio-cerebral vascular disease during half to 6-year flow-up.Conclusion:Simultaneous OPCABG and CEA is safety and effective for patients combined coronary heart disease and carotid artery stenosis.The early and medium-term effects are satisfactory.
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