Chang Y, Shih C T, Lai S T
Department of Surgery, National Yang-Ming University, Taipei, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1994 Sep;54(3):156-9.
Coronary Endarterectomy is a controversial but effective procedure for diffuse coronary artherosclerosis. Between April 1991 and January 1993, 57 patients in VGH-Taipei who had their diffuse coronary artery disease treated with combined endarterectomy and coronary artery bypass grafting (CABG).
One hundred and thirty-eight endarterectomies were performed, including 6 on the left main coronary artery system, 77 on the left anterior descending coronary artery system, 15 on left circumflex coronary artery system and 40 on the right coronary artery system (an average of 2.42 endarterectomies/patient). For graft conduit, great saphenous vein was used in 149 anastomoses, left internal mammary artery in 21, right internal mammary artery in 6 and right gastroepiploic artery in 4. The mean number of distal graft anastomoses was 3.15 per patient. Additional procedures were performed in 8 patients (14%): two patients required aortic valve replacement, one patient had mitral valve replacement, one had mitral annuloplasty, one had VSD repair and three had left ventricle aneurysm plications. The mean aortic clamp time was 108.8 +/- 30.5 minutes.
The early mortality rate was 5.3%. The late mortality rate was 3.5%. During follow-up of mean 17.5 months, 98% of survivors were asymptomatic or in improved condition.
Although endarterectomy is still a debatable procedure, it is valuable especially for the diffusely diseased arteries.
冠状动脉内膜切除术对于弥漫性冠状动脉粥样硬化而言是一种存在争议但有效的手术。在1991年4月至1993年1月期间，台北荣民总医院的57例弥漫性冠状动脉疾病患者接受了内膜切除术与冠状动脉旁路移植术（CABG）联合治疗。
共进行了138次内膜切除术，其中6次针对左主冠状动脉系统，77次针对左前降支冠状动脉系统，15次针对左旋支冠状动脉系统，40次针对右冠状动脉系统（平均每位患者2.42次内膜切除术）。对于移植血管，149次吻合使用了大隐静脉，21次使用了左乳内动脉，6次使用了右乳内动脉，4次使用了右胃网膜动脉。每位患者远端移植吻合的平均次数为3.15次。8例患者（14%）进行了额外手术：2例患者需要进行主动脉瓣置换，1例患者进行了二尖瓣置换，1例进行了二尖瓣环成形术，1例进行了室间隔缺损修复，3例进行了左心室动脉瘤折叠术。平均主动脉阻断时间为108.8 +/- 30.5分钟。
早期死亡率为5.3%。晚期死亡率为3.5%。在平均17.5个月的随访期间，98%的幸存者无症状或病情有所改善。
尽管内膜切除术仍是一个有争议的手术，但它尤其对于弥漫性病变动脉具有价值。
