目的：探讨冠状动脉（冠脉）内膜剥脱技术（CE）在冠脉搭桥手术（CABG）中的应用，并评估其近中期效果。方法31例在CABG同时进行CE的患者为CE组，从同期行CABG的患者中挑选与CE组患者病情相仿的31例患者为对照组；观察并比较2组患者的术中参数、术后恢复情况和中期随访结果，并总结CE的技术要点。结果 CE组31例患者共行冠脉内膜剥脱35处，其中左前降支系统13支（37%，其中左前降支6支、对角支7支），回旋支系统3支（9%），右冠状动脉系统19支（54%，其中主干8支、后降支11支）；4例患者同时行2支血管内膜剥脱。CE组与对照组的主动脉阻断时间、体外循环时间、桥血管流量、搏动指数和机械通气时间等指标差异无统计学意义；2组均无围术期心肌梗死和手术死亡；CE组随访无心绞痛发作，1例术后6个月由于心功能不全并发真菌性肺炎死亡。结论CE是CABG的必要的辅助技术，其与单纯CABG相比手术死亡和主要的并发症发生率无显著差异，近期和中期效果良好。%Objective To study the application of coronary endarterectomy (CE) in coronary artery bypass graft (CABG), and to evaluate the effect of CE plus CABG on patients with chronic total occlusion (CTO) combined with diffuse distal atherosclerosis. Methods Thirty one patients, who underwent coronary endarterectomy in our institution between Oc-tober 2009 and October 2012, were reviewed retrospectively and compared the control group with 31 patients of their age, sex, LV function, and angina class. Results Among the 31 patients, 27 patients underwent one, 4 patient underwent two coronary arteries endarterectomized. Of all these 35 total endarterectomies, 13 (37%) were at left anterior descending artery, 3(9%) were at branches of the circumflex artery, and 19 (54%) involved the right coronary artery. There was no statistical dif-ference between two groups in clinical parameters including aorta cross time, cardiopulmonary bypass time, graft runoff, pul-sation index and mechanism ventilate time (P>0.05). There was no perioperative myocardial infarctions in CE group nor in control group. All patients were followed up and no recurrent angina were present in CE group. In CE group, one patient died of fungal pneumonia and heart failure half a year after operation. Conclusion In current cardiac surgical practice, coronary endarterectomy is an indispensable adjunct to CABG. The operative mortality and major morbidity were comparable or simi-lar to coronary artery bypass grafting, but its short-term and medium-term results were more favorable than to CABG.
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