经左胸肋间切口实施冠状动脉旁路移植术  

Coronary artery bypass grafting via left intercostal thoracotomy approach

作　　者：万峰[1] 陈彧[1] 

机构地区：[1]北京大学人民医院心脏外科,北京100044

出　　处：《中国微创外科杂志》2006年第6期418-420,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的 探讨经左胸肋间切口实施冠状动脉旁路移植术的临床应用与特点. 方法 我院1996年9月～2005年8月共实施经左胸肋间切口的冠状动脉旁路移植术36例,左侧胸骨旁第4肋间前外侧切口6～10 cm进入胸膜腔,使用MIDCAB专用牵开器,分离左侧乳内动脉与冠状动脉吻合.主要有4种情况：①单纯前降支系统病变;②再次冠状动脉旁路移植术而存在通畅的左乳内动脉至前降支桥;③严重的升主动脉钙化;④合并其他左胸手术.单支病变26例,双支病变3例,三支病变7例.既往介入治疗史5例,冠状动脉旁路移植术史6例.左心室射血分数为（0.562±0.107）. 结果 36例均成功实施非体外循环心脏跳动下的冠状动脉旁路移植术,远端吻合口1～4个,手术时间（190.4±44.1） min.合并激光心肌打孔术2例,合并肺癌切除术1例,食管癌切除术1例.无住院死亡病例.32例随访1个月～9年,中位数32月,2例远期死亡.2例术后1年再发心绞痛,1例经介入治疗,另1例再次手术,症状消失.其余患者均没有心绞痛症状. 结论 经左胸肋间切口实施冠状动脉旁路移植术对某些特殊类型的冠心病患者是安全实用的选择,非体外循环方式下进行此类手术是可行的.Objective To discuss the clinical application and features of coronary artery bypass grafting （CABG） through left intercostal thoracotomy approach. Methods A total of 36 cases of CABG were performed through left intercostal thoracotomy approach from September 1996 to August 2005 in this hospital. The patients fell into four categories ： ①single vessel disease in the left anterior descending artery （LAD） ; ②re-operation of CABG with a patent LIMA （left internal mammary artery）-LAD bypass; ③severe calcified ascending aorta; and ④concurrent other procedures that required left thoracotomy. There were 26 cases of single vessel disease, 3 cases of double vessel disease, and 7 cases of triple vessel disease. Five cases had a history of percutaneous coronary interventions （PCIs） and 6 cases had a history of CABGs. The left ventricular ejection fraction was 0. 562 ±0. 107. Results Off pump CABG with 1 -4 distal anastomosis was successfully accomplished in a11 the 36 cases, with an operation time of 190.4 ± 44.1 min. Concurrent procedures included 2 cases of transmyocardial laser revascularization （TMLR） , 1 case of lung cancer resection, and 1 case of esophageal cancer resection. There was no in-hospital mortality. Two fatal cases were seen in long-term follow-up observations. Recurrent angina developed in 2 cases 1 year after operation, and was cured with a PCI in 1 case and with a re-operation of CABG in 1 case. Conclusions The left intercostal thoracotomy is a safe and feasible approach for CABG surgery in patients with some special types of coronary heart disease. The procedure can be performed under beating heart.

关 键 词：冠状动脉旁路移植术 再次手术 非体外循环 

分 类 号：R654.2[医药卫生—外科学]