心脏镜多支冠状动脉搭桥术的动物实验研究  

Cardioscopic multivessel coronary artery bypass grafting in animal models

作　　者：王强[1] 肖明第[1] 程云阁[2] 袁忠祥[1] 卢成宝[1] 吕志前[1] 

机构地区：[1]上海交通大学附属第一人民医院心外科,上海200080 [2]第四军医大学附属西京医院心外科,陕西西安710032

出　　处：《中国内镜杂志》2006年第2期161-163,171,共4页China Journal of Endoscopy

摘　　要：目的探讨心脏镜即不需辅助小切口的完全内镜下多支冠状动脉搭桥术术式的可行性。方法实验动物为2头猪和24条狗,胸壁打孔,进行多支冠状动脉搭桥手术的操作。结果经过1.5cm的3、4个小孔可以完成右冠状动脉、左冠状动脉、前降支、对角支及回旋支等多支冠状动脉的搭桥手术,并能顺利完成左锁骨下动脉、降主动脉的远端吻合口的吻合操作。结论心脏镜多支冠状动脉搭桥术切实可行,值得进一步研究。不久的将来有可能成为心脏搭桥术的主要术式。[Objective] In an effort to minimize access in multivessel coronary artery bypass grafting （CABG） surgery, a total endoscopic approach using cardioscopic technology was developed. The application of an cardioscopy enables closed chest coronary artery bypass via a three or four-point stab incision avoiding sternotomy and minithoracotomy. [Methods] The cardioscopic procedures of multivessel coronary artery bypass grafting（CCAB） were performed via a three or four-point incision on 2 pocines and 24 dogs. Distal anastomoses were made with running 7-0 or 8-0 Prolene running suture, and proximal anastomoses were made with running 6-0 Prolene running suture. Seventy one distal and thirty nine proximal anastomoses were performed using the cardioscopy system operation. After baseline training the following procedure modules were carried out in a stepwise manner： cardioscopic left internal thoracic artery harvesting, a hand-sewn suturing of internal thoracic arteries（ITA） to left anterior descending anastomoses（LAD）or to light coronary arteries, hand-sewn saphenous vein grafts （SVG） to left coronary arteries, diagonal branches, or the left circumflex coronary artery （LCX）. [Result] Multivessel coronary artery bypass grafting was accomplished through 3-4 po,-ts in the left intercostal space with cardioscopy. Of the seventy one distal anastomoses, seventeen leaked and were repaired manually, and all grafts but one were patent although minor strictures were found in five. At sacrifice, magnified inspection of the coronary anastomoses revealed widely patent anastomoses in 17 of 71 anastomoses; in 17 cases, the anastomoses were slightly strictured but patent and permitted the passage of a 1.0-1.5 mm probe. The mild strictures were due to a pursestring effect of the sutures and discordant arteriotomies relative to the graft diameters. Of the thirty nine proximal anastomoses, nine leaked and were repaired manually, and all grafts were patent. [Conclusion] Endoscopic ITA harvesting and performing of arteri

关 键 词：心脏镜 冠状动脉搭桥术 动物模型 

分 类 号：R541.4[医药卫生—心血管疾病] R332[医药卫生—内科学]