熊绍辉,张栗,卢孔杰,程震锋

• 1:湖州师范学院医学院(护理学院)
• 2:湖州师范学院附属中心医院

摘要(Abstract)：

20世纪中期，内乳动脉（IMA）结扎术因改善动物心肌缺血存活率及缓解心绞痛症状引发关注，但假手术实验证实其疗效源于安慰效应而被淘汰。近年介入技术进步推动IMA远端封堵复兴，研究证实其通过调控侧支循环改善心肌灌注。随机对照试验进一步显示，封堵治疗组心绞痛缓解率显著优于假手术组，尤其对右冠状动脉（RCA）及左前降支（LAD）病变有效，但左回旋支因缺乏IMA侧支连接而无获益。解剖学表明，IMA通过心包膈动脉与RCA/LAD形成天然侧支通路，是其疗效的解剖基础。当前技术局限包括封堵不完全、器械相关并发症及长期预后证据不足。未来需优化封堵器械设计、探索联合治疗策略，并开展与传统血运重建技术的对照研究。本综述系统梳理IMA封堵技术的百年演变，从外科结扎到精准介入的范式转变，解析其解剖与血流动力学机制，整合循证证据并提出适应证筛选标准，为无法耐受冠状动脉旁路移植术和（或）经皮冠状动脉介入治疗的高危患者提供个体化治疗新路径。

关键词(KeyWords)： 内乳动脉介入;冠状动脉疾病;侧支循环;心肌灌注

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 熊绍辉,张栗,卢孔杰,程震锋

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