胸腔镜冠状动脉搭桥手术实验研究  

CORONARY ARTERY BYPASS GRAFTING WITHOUT EXTRACORPOREAL CIRCULATIONTHROUGH A MINIMAL THORACOTOMY AND THORACOSCOPY—AN ANIMAL EXPERIMENT

作　　者：张仁尧[1] 刘桐林[1] 李剑锋[1] 杨泽泉[1] 庾华东[1] 王进[1] 吴栋[1] 陈鸿义[1] 

机构地区：[1]北京医科大学第一医院胸心外科

出　　处：《北京医科大学学报》1998年第2期148-150,共3页Journal of Peking University(Health Sciences)

摘　　要：目的：寻找经胸腔镜及胸部小切口行冠状动脉搭桥手术过程中的技术要点，以便进一步完善和推广该项技术。方法：杂种犬１１只，用胸腔镜取乳内动脉，然后在非体外循环下，在跳动的心脏上完成乳内动脉和冠状动脉（前降支）吻合。结果：取前４条乳内动脉，所用时间为６０～８０ｍｉｎ，在离断分支时有出血。取后７条乳内动脉所用时间为３０～５０ｍｉｎ。６条为单支，５条为带蒂血管。所取１１条乳内动脉皆可用作动脉桥。前４条乳内动脉和前降支吻合不满意，原因是技术不熟练，冠状动脉吻合口喷血致术野不清。犬的心率太快（１３０～１５０次／分），影响精细操作。改进方法后，后７个吻合口满意。结论：控制吻合口出血，减慢心率，减少吻合口处的心脏运动幅度，防止室颤是该项手术的技术要点。Objetive: A new surgical bypass technique for harvesting left intramammary artery(LIMA) and mammaryleft anterior descending artery(LAD) through a minimal thoracotomy without extracorporeal circulation was evaluated in this animal experiment. Methods:Eleven mongrel dogs were used.LIMA was harvested by use of thoracoscopy. And then, a minimal anterior thoracotomy was performed and the LIMA was anastomosed directly to LAD on the beating heart without extracorporeal circulation. Results:The LIMA was dissected up to the first costal space.It took about 60 to 80 minutes for harvesting the first four LIMAs. The harvesting time was down to 30 to 50 minutes for the 7 left. All the 11 LIMAs could be used for the bypass procedures. The first 4 anastomoses failed because of bleeding from the anastomotic sites, tachycardia(130～150　beat/min). The following 7 were successful owing to satisfactory control of the above problems.　Conclusion:Controlling the anastomotic bleeding,　slowing down the heart rate,　decreasing the local muscular motion around the anastomotic area,and preventing ventricular fibrillation were important procedures.　The data indicate that this operation is safe and technically feasible for the clinical use.

关 键 词：冠状动脉搭桥术 胸腔镜 冠状动脉 外科手术 

分 类 号：R654.2[医药卫生—外科学]