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目的评估经皮介入封堵术治疗冠状动脉瘘的疗效,并总结单中心经验。方法回顾性分析2009年8月至2015年8月在第二军医大学长海医院成功行经皮冠状动脉瘘封堵术治疗的70例患者的临床资料。结果 70例患者中男性42例(60.00%),女性28例(40.00%),平均年龄为(56.30±15.54)岁(15~83岁)。共有101个瘘,其中瘘管起源于左主干9例(8.91%),前降支43例(42.57%),回旋支15例(14.85%),右冠34例(33.67%);瘘终止于肺动脉79例(78.22%),右心房16例(15.84%),右心室2例(1.98%),其他4例(3.96%)。瘘管的平均直径为(3.95±2.61)mm,均封堵成功,其中使用弹簧圈封堵60例(85.71%),平均植入弹簧圈(2.55±1.76)枚;动脉导管未闭封堵器封堵5例(7.14%),plug封堵2例(2.86%),肌部室间隔缺损封堵器封堵2例(2.86%),封堵器的平均直径为(13.33±4.32)mm;带膜支架封堵1例(1.43%)。术后服用阿司匹林肠溶片3~5mg/(kg·d)6个月,随访1~73个月,平均(33.94±20.93)个月,患者均未发生出血、溶血、栓塞、胸痛及其他不良反应。结论经皮介入封堵冠状动脉瘘是安全、有效,手术创伤小,可在临床推广应用。
Objective To evaluate the efficacy of percutaneous closure in the treatment of coronary artery fistula and to summarize the single-center experience. Methods The clinical data of 70 patients who underwent successful percutaneous coronary artery occlusion in Changhai Hospital, Second Military Medical University from August 2009 to August 2015 were retrospectively analyzed. Results Among the 70 patients, 42 were male (60.00%) and 28 were female (40.00%). The average age was (56.30 ± 15.54) years old (15-83 years old). There were 101 fistulas, of which fistula originated from left main trunk in 9 cases (8.91%), anterior descending branch in 43 cases (42.57%), circumflex artery in 15 cases (14.85%) and right crown in 34 cases (33.67% 79 cases (78.22%), right atrium in 16 cases (15.84%), right ventricular in 2 cases (1.98%) and the other 4 cases (3.96%). The average diameter of the fistula was (3.95 ± 2.61) mm, and the occlusion was successful. Among them, 60 cases (85.71%) were occluded with coils, and 2.55 ± 1.76 cases 2 cases (2.86%) were occluded with plug, 2 cases (2.86%) occluded with muscular ventricular septal defect occluder, and (13.33 ± 4.32) mm occluded with membrane; Stent closure in 1 case (1.43%). Postoperative aspirin enteric-coated tablets 3 ~ 5mg / (kg · d) for 6 months, followed up for 1 to 73 months, an average of (33.94 ± 20.93) months, no bleeding, hemolysis, embolism, chest pain and other adverse reactions reaction. Conclusion Percutaneous coronary occlusion is safe, effective and less traumatic. It can be widely applied in clinical practice.