胸骨下段正中小切口直视冠状动脉旁路移植术  

Minimally Invasive Direct Coronary Artery Bypass Grafting Through Lower Median Ministernotomy

作　　者：马维国[1] 孙寒松[1] 胡盛寿[1] 许建屏[1] 吕锋[1] 朱晓东[1] 

机构地区：[1]中国医学科学院中国协和医科大学阜外心血管病医院心脏外科,北京100037

出　　处：《中国胸心血管外科临床杂志》2005年第4期240-242,共3页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的总结72例胸骨正中下段小切口直视冠状动脉旁路移植术(MIDCAB)的经验,探讨其手术方法和适应证.方法经胸骨下段正中小切口游离左乳内动脉用于左前降支旁路移植,并切取大隐静脉,在非体外循环下完成单支或多支病变血管的冠状动脉旁路移植手术.结果手术死亡1例(1.4%),术后发生并发症3例(4.2%).手术时间195.6±50.6 min,吻合口数2.3±0.8个(1～4个);术后气管内插管时间0～364 h,中位数11 h;住ICU时间1～23 d,中位数3 d;术后住院时间10.9±5.4 d(6～36 d,中位数9 d);胸腔引流量8.5±5.9 ml/kg;47例患者需输血,输血量为1 091.3±636.2 ml;所有患者胸部切口长9～11 cm.术后随访时间36.2±17.6个月,随访率92.9%(66/71),无远期死亡,心绞痛完全免除率65.2%(43/66);明显改善占27.3%(18/66).结论胸骨正中下段小切口直视下冠状动脉旁路移植术创伤小,无须特殊器械;皮肤切口小,美观;操作简单,安全可靠,可获得冠状动脉多支病变充分再血管化的效果.Objective To review our experience of minimally invasive direct coronary artery bypass grafting （MIDCAB） via a lower median ministernotomy in 72 cases. Methods Via a lower median ministernotomy,the left internal mammary artery was harvested to bypass the left anterior descending coronary artery. Saphenous vein was resected and used for single - or multi-vessel coronary revascularization on the beating heart. Results There were 1 operative death （1.4 % ）. Complications occurred in 3 patients （4.2%）. The operative duration was 195.6 ± 50. 6 min. The number of distal anastomoses was 2.3±0. 8（1-4）. The median time to tracheal extubation, and lengths of postoperative ICU and hospital stays were 11 hours, 3 and 9 days, respectively. Total chest drainage was 8. 54±5.9 ml/kg and 47 patients needed blood transfusion with an amount of 1 091.3±636.2 ml. The incision on the chest wall was 9 to 11 cm long in all cases. Sixty-six patients （92.9%, 66/71） were followed-up for a duration of 36.2±17.6 months. There were no late death and 43 patients （65.2%） were free from angina. Eighteen patients （27.3%, 18/ 66） experienced marked relief of their symptoms. Conclusions MIDCAB is possible via a lower ministernotomy for single - or multi-vessel coronary revascularization. The small incision reduces the risk of infection and blood loss. It is safe, easy and requires no special operative instruments.

关 键 词：冠状动脉旁路移植术 胸骨 微创 

分 类 号：R654.2[医药卫生—外科学]