乳内动脉skeleton取材法在冠状动脉旁路移植术中的应用  

A "skeletonized" Harvesting Technique of Internal Mammary Artery in Coronary Artery Bypass Grafting

作　　者：熊利华[1] 华平[1] 李佳[1] 张惠忠[1] 魏益平[1] 王铭辉[1] 张华[1] Olivier BICAL 

机构地区：[1]中山大学附属第二医院心胸外科,广州510120 [2]法国巴黎St-Joseph医院心脏外科,法国巴黎75014

出　　处：《中国胸心血管外科临床杂志》2007年第4期252-255,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的 评价乳内动脉skeleton取材法在冠状动脉旁路移植术（CABG）中的应用及其效果。方法 277例接受CABG的患者（其中合并糖尿病33例）在术中分离乳内动脉的过程中，仅使用剪刀和钛夹来分离乳内动脉，即不附带任何周围组织的skeleton取材法游离一侧或两侧乳内动脉，其中21例糖尿病患者取用双侧乳内动脉；并观察患者术中、术后的临床结果。采用非体外循环CABG5例，体外循环CABG272例。结果 体外循环时间60～217min，平均90．1min；主动脉阻断时间30～160min，平均53．3min。手术死亡率2．2％（6／277）。手术中见乳内动脉桥质量良好，动脉桥血流量满意；术后移植血管通畅，心绞痛症状消失。取用双侧乳内动脉和糖尿病患者亦未出现更高的胸骨感染率。手术后冠状动脉造影显示乳内动脉血管桥通畅。结论 乳内动脉skeleton取材法有良好的血管桥通畅率，对患者胸骨创伤较小，对糖尿病患者取用双侧乳内动脉不再是禁忌证。Objective To evaluate the outcome of the skeletonized harvesting method of internal mammary artery （IMA） in coronary artery bypass grafting （CABG）, and its apply. Methods Two hundred and seventy- seven patients （diabetic 33）underwent myocardial revascularization. Left IMA （n=100） or both side of IMA （n= 177） were totally skeletonized from the surrounding tissues just by use of the scissors and the titanium clips without the use of electrocautery during harvesting,both side of IMA were harvested in 21 diabetics. Five cases were done with non-extracorporeal circulation CABG and 272 cases were done with extracorporeal circulation CABG. Results The extracorporeal circulation time was 60 to 217min （average 90. 1min）, aortic clampping time was 30 to 160min （average 53.3min）. Operative mortality was 2.2% （6/227）. The IMA grafting has revealed a good quality and blood flow was fluent enough to meet the myocardial need perioperatively. All patients had a disappearance of angina pectoris. Harvesting of both side of IMA in patients, even for those diabetes, had not revealed a higher sternum inflammation. Coronary angiography showed a good patency. Conclusion The skeletonized harvesting method of IMA has a good flow patency rate and a less sternum injury during the harvesting procedure. Harvesting both sides IMA is no longer a contraindication in diabetics.

关 键 词：乳内动脉 Skeleton取材法 冠状动脉旁路移植术 

分 类 号：R654.2[医药卫生—外科学]