主动脉隔离技术应用于非体外冠脉手术中期疗效评估  

Mid-term Evaluation of Aortic Exclusion Technique with Enclose Device in Off Pump CABG

作　　者：孔烨[1] 隋亮[2] 章剑锋[2] 朱良纲[2] 杭钧彪[2] 沈振亚[1] 

机构地区：[1]苏州大学附属第一医院心血管外科,江苏苏州215006 [2]上海交通大学医学院附属瑞金医院心胸外科,上海200025

出　　处：《中国临床医学》2008年第3期290-292,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:总结主动脉隔离技术用于非体外循环冠状动脉旁路移植手术的经验,探讨其可行性与安全性,评估中期临床疗效。方法:在180例非体外循环下冠状动脉旁路移植手术中,应用Enclose装置,以主动脉隔离技术完成桥血管与升主动脉近端吻合。术前用薄层CT平扫评价升主动脉粥样硬化及钙化程度,术中用超声检查升主动脉结合手指扪查升主动脉。23例(12.8%)存在明显升主动脉粥样硬化斑块或钙化灶。术中再血管化的顺序为:(1)应用主动脉隔离技术,完成所有静脉或桡动脉桥血管与主动脉近端吻合;(2)左乳内动脉与左前降支远端吻合;(3)顺次完成所有桥血管与冠状动脉远端吻合。术后常规应用肠溶阿司匹林及硫酸氢氯吡格雷抗血小板治疗。结果:共完成桥血管536根,平均2.98±0.8根.例-1。用主动脉隔离技术成功完成近端吻合口408个;其中,桡动脉桥近端吻合口7个,静脉桥近端吻合口401个,平均2.27±0.7个.例-1。术中无技术故障和相关意外情况发生。围手术期死亡4例(2.2%)。176例存活患者无心肌梗死、脑梗死、主动脉夹层动脉瘤、二次开胸止血及心功能衰竭等严重围术期并发症和心脏相关事件发生。术后147例(83.5%)存活患者接受门诊或电话随访,随访时间27.7±9.4(6～39)个月。1例(0.7%)患者术后15个月死于肠道肿瘤;胸痛发生率2.7%、房颤发生率2.0%、脑梗发生率3.4%、下肢栓塞发生率1.4%。全组患者无其它心血管不良事件发生。术后心功能NYHA分级较手术前明显改善(P<0.05)。术后30个月以上的25例患者行冠状动脉CTA检查,结果58个桥血管近端吻合口中53个(91.4%)近端吻合口均通畅。结论:用Enclose装置的主动动脉隔离技术可安全地用于非体外冠脉旁路移植术的近端吻合,尤其可用于升主动脉明显钙化和粥样硬化的患者,术后中期疗效满意。Objective：To report our experience of aortic exclusion technique with Enclose device for constructing proximal anastomoses in off pump CABG,and to evaluate the mid-term clinical results.Methods：180 patients underwent off pump CABG using aortic exclusion technique with Enclose device for constructing proximal anastomoses in our hospital.Pre-operative ascending aortic CT scan,intra-operative finger palpation combined with intra-operative aortic ultrasonic examination were used to access the extent of atherosclerosis and calcification of aorta.23（12.8%）patients were found to have significant calcified atherosclerotic plaques in the ascending aorta.The sequence of revascularization was：（1）LIMA to LAD.（2） Aortic exclusion technique to accomplish proximal anastomoses by using the Enclose devices.（3）Distal graft to coronary artery anastomoses.The patients was followed up post-operatively by telephone interview or clinic visit.Results：There were total 536 grafts accomplished in this group,with average 2.98±0.8 graft.patient^-1.A total of 408 proximal anastomoses were performed with this technique,average 2.27±0.7 per patient,without technical problem or failure.There were 4（2.2%） patients expired perioperatively.All the others were discharged without major post-operative complications.Follow-up was available in 147（83.5%）patients in 27.7±9.4 months（6～39months）.Follow-up data revealed that 1 patient expired of intestinal carcinoma 15 months after surgery,and recurrent of chest pain in 4（2.7%）patients,atrial fibrillation in 3（2.0%）patients,stroke in 5（3.4%）patients,lower extremity emboli in 2（1.4%）patients.A significant improve in NYHA class was observed in this follow-up patient group（P〈0.05）.Coronary CT angiography were performed in 25 patients over 30 months after surgery,which revealed 53（91.4%）patent proximal anastomoses out of 58 grafts performed.Conclusion：Aortic exclusion technique with Enclose device for proximal graft anastomoses could be used s

关 键 词：主动脉隔离技术 Enclos装置 非体外循环下冠状动脉旁路移植 

分 类 号：R654.3[医药卫生—外科学]