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目的探讨具有介入操作指导意义的冠状动脉分叉病变分型方法。方法根据冠状动脉分支参考直径和病变对称性对分叉病变进行分型,并在此基础上设计介入治疗原则。(1)首先根据分支参考直径将分叉病变分为分支对等型和分支优势型。(2)然后根据分叉处病变是否对称分为对称型和非对称型两个亚类。(3)对于分支优势型非对称分叉病变再根据病变部位分为A、B两个亚型。(4)对等对称型分叉病变原则上采用双支架术,全部对吻扩张;其他类型原则上采用单支架术,非支架分支开口70%残余狭窄者对吻扩张。结果按照新分型法的使用时间将连续300例老年冠心病分叉病变分为传统分型组(Lefevre组)和新分型组(ERDALS组)各150例,两组手术成功率都是100%,与Lefevre组相比,分叉病变支架使用率(1.2%比1.5%)、双支架率(23.3%比52%)、操作时间(15.3min比21.6min)和随访心脏事件率(1.3%比3.3%)明显优于Lefevre组(P<0.05)。结论按照分支参考直径和病变对称性设计分叉病变分型法具有简便、直观、系统和操作性强的优点,对临床介入治疗具有指导意义。
Objective To investigate the classification of coronary bifurcation lesions with the guiding significance of intervention. Methods The bifurcation lesion was classified according to the reference diameter of coronary artery branches and the symmetry of the lesion. On the basis of this, the principle of interventional therapy was designed. (1) Firstly, the bifurcation lesions were divided into branch-type and branch-type according to branch reference diameter. (2) Then according to the bifurcation lesions symmetry is divided into two types of symmetry and asymmetry. (3) for the branch of the advantages of asymmetric bifurcation lesions and then divided into A, B two subtypes. (4) Equivalent symmetrical bifurcation lesions in principle using double stenting, all kiss expansion; other types of single stent in principle, non-stent graft opening 70% residual stenosis kiss expansion. Results According to the time of using new typing method, 300 consecutive cases of coronary heart disease were divided into 150 cases in each of the traditional classification group (Lefevre group) and the new classification group (ERDALS group). The successful rates of the two groups were all 100 (1.2% vs 1.5%), double stent rate (23.3% vs. 52%), duration of operation (15.3min vs. 21.6min), and follow-up cardiac event rate (1.3%) compared with the Lefevre group (3.3%) than Lefevre group (P <0.05). Conclusion The design of bifurcation lesion classification method based on branch reference diameter and lesion symmetry has the advantages of simplicity, intuition, strong system and operability and is instructive for clinical intervention.