解剖完全再血管化是冠心病外科治疗的新策略

doi:10.6040/j.issn.1671-7554.0.2024.0771

摘要/Abstract

摘要： 冠状动脉旁路移植术(coronary artery bypass grafting, CABG)中完全再血管化(complete revascularization, CR)近来受到越来多的重视,CR分为解剖完全再血管化(anatomic complete revascularization, ACR)与功能完全再血管化(functional complete revascularization, FCR)。多项研究证实CR的CABG患者围手术期安全、中远期效果更好。近来全球多中心随机对照临床试验ISCHEMIA研究证实,对于稳定型缺血性心脏病,ACR与FCR均比非完全再血管化和药物保守治疗更能改善稳定性心绞痛患者心绞痛相关的健康状况、生活质量,减少心脏死亡与心肌梗死的发生,并改善中-长期临床效果,而且ACR明显优于FCR。ACR是CABG的新治疗策略,尽管存在亟待解决的问题,但可望为改善CABG疗效提供新的思路并在全动脉CABG、慢性缺血性心肌病患者CABG以及冠脉杂交手术中产生广泛的应用前景。

关键词: 冠心病, 冠状动脉旁路移植术, 完全再血管化, 解剖完全再血管化

Abstract: Complete revascularization(CR)has received increasing attention in coronary artery bypass grafting(CABG)and is categorized as anatomic complete revascularization(ACR)and functional complete revascularization(FCR). Multiple clinical trials validated that CR was associated with improved mid-term and long-term clinical outcomes in CABG. A recent randomized controlled multicenter trial(ISCHEMIA study)showed that both ACR and FCR in CABG led to improved angina-related health status and life quality, reduced incidence of cardiac death and myocardial infarction, and improved mid-term and long-term outcomes compared with incomplete revascularization and conservative management in patients with stable ischemic heart disease, more pronounced with ACR than FCR. Although there are urgent problems to be solved, ACR, as a new surgical strategy, might offer a new perspective for improving safety and efficacy of CABG and promise to be widely used in total arterial CABG, surgical treatment of chronic ischemic cardiomyopathy, and hybrid coronary revascularization.

Key words: Coronary heart disease, Coronary artery bypass grafting, Complete revascularization, Anatomic complete revascularization

中图分类号:

R654

陈绪军,申林,陈军,于涛,曹广庆,肖飞. 解剖完全再血管化是冠心病外科治疗的新策略[J]. 山东大学学报 (医学版), 2025, 63(5): 12-17.

CHEN Xujun, SHEN Lin, CHEN Jun, YU Tao, CAO Guangqing, XIAO Fei. Anatomic complete revascularization is a new strategy of surgical treatment for coronary heart disease[J]. Journal of Shandong University (Health Sciences), 2025, 63(5): 12-17.

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