不停跳下冠状动脉旁路移植加左心室室壁瘤闭式成形术46例  

46 cases of off-pump CABG and plication of left ventricular aneurysm

作　　者：刘锐[1] 顾承雄[1] 韦华[1] 侯立成[1] 胡晖[1] 刘虎[1] 

机构地区：[1]首都医科大学附属北京安贞医院心外科,100029

出　　处：《中华胸心血管外科杂志》2005年第4期234-235,共2页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的总结46例不停跳下冠状动脉旁路移植(冠脉搭桥)加左心室室壁瘤闭式成形术的手术经验。方法在非体外循环及不停跳下以1.0～1.5mg/kg体重肝素抗凝。明确室壁瘤基底位置及其长度以20Surgipro843缝线平行左心室长轴加毡片行间断褥式缝合,使瘤腔与左心室功能心腔隔离。45例同期行冠脉搭桥术。结果27例搭桥3根,12例搭桥2根,6例搭桥1根。39例应用左乳内动脉吻合于前降支,3例于转机不停跳下完成手术,2例行前降支内膜剥脱术,2例应用IABP。全组死亡1例。余者无术后心梗发生,10～14d治愈出院。结论不停跳下冠脉搭桥加左心室室壁瘤闭式成形术可有效消除左心室矛盾运动及无效心腔,加固薄弱心室壁,防止心脏破裂;减少恶性心律失常发生;避免体外循环并发症。Objective To review the experience of OPCAB and phcation of left ventricular aneurysm. Methods Without cardiopulmenary bypass, heparin was given at 1.0 - 1.5 mg/kg.The 2-0 Surgipro 843 sutures were placed across the base of aneurysm using a strip of teflon felt on either side. The suture line was oriented to reconstruct a relatively normal left ventricular contour. Concurrent CABG was performed. Results 46 cases were reviewed. Left internal mammary artery （LIMA） gratis to the LAD were performed in 39 cases, off-pump with eardiopulmonary bypass in 3, IABP were used in 2. One patient died of left ventricular dysfunction. The other patients had no new myocardial infarctions and were discharged 10 to 14 postoperative days. Condusion OPCAB and plication of left ventricular aneurysm could obviously decrease the risk of cardiac rupture and avoid the complications of cardiopulmonary bypass.

关 键 词：心脏室壁瘤/外科学 冠状动脉分流术/方法 冠状动脉旁路移植 左心室室壁瘤 不停跳 成形术 闭式 冠脉搭桥术 非体外循环 恶性心律失常 

分 类 号：R654.2[医药卫生—外科学] R732.1[医药卫生—临床医学]