微创冠状动脉搭桥术初步报告  

Primary Report of Minimal Invasive Coronary Bypass Surgery

作　　者：赵强[1] 王宜青[1] 夏利民 

机构地区：[1]上海医科大学中山医院心脏外科,上海市心血管病研究所,200032

出　　处：《中国临床医学》1999年第2期143-144,共2页Chinese Journal of Clinical Medicine

摘　　要：目的：微创冠状动脉搭桥术可减少体外循环引起的并发症，患者术后疼痛轻，恢复快，出血输血少，住院时间短，医疗费用低。方法：自1998年8月至1999年4月采用前胸正中切口，应用左胸廓内动脉、双侧胸廓内动脉和大隐静脉为12例冠心病患者施行微创冠状动脉搭桥术，占同期冠状动脉搭桥术22％。年龄45～80岁（平均65岁），左室射血分数23％～69％（平均47％），平均搭桥2．1根。结果：平均ICU时间和住院时间分别为1～2d（平均1.2d）和12～20d（平均12d）术后平均6d出院，较同期常规冠状动脉搭桥术短（P＜0.05）。胸腔引流量和输血分别为280～750ml（平均415ml），0～600ml（平均160ml），较同期常规冠状动脉搭桥术少（P＜0.05）。11例手术存活，1例死于呼吸衰竭。短期随访（1～8个月）患者心绞痛症状消失，活动量增加。2例患者术后2个月随访冠脉造影，吻合口满意率100％。结论：微创冠状动脉搭桥术安全、经济、有效，并可应用于多支血管病变，值得推广应用。Objective: Minimal invasive coronary bypass surgery decreases the complication associated with cardiopulmonary bypass, alleviates postoperative pain, promotes recovery, and is economical. Methods: From August 1998 to April 1999, twelve patients underwent minimal invasive coronary bypass surgery with LIMA, bilateral mammary artery, and saphenous vein grafts through medial sternotomy. This accounted for 22 % patients of all candidates for coronary bypass surgery. Patient's age rang is 45 to 80 (average 65) yearsold, and left ventricular ejection fraction is between 23 % to 69 % (average 47 % ). The average graft is 2. 1 per case. Results: The average ICU and hospital stay were 1. 2 and 12 days, respectively, shorter than conventional coronary bypass surgery (p < 0. 05). Patients are usually discharged 5 ～6 days postoperatively. The average chest drainage and blood trans fusion were 415 ml and 160 ml, respectively, less than conventional bypass surgery (p < 0.05). Eleven patients survived from surgery. One patient died one week postoperatively from respiratory dysfunction due to chronic obstructive pulmonary disease. All survived patients have no symptoms of angina for short - term follow - up (1 to 8 months). Two patients were followed up with postoperative coronary angiogram 2 month later. 100 % satisfaction of anastomosis. Conclusious: Minimal invasive coronary bypass surgery is more safe, economical and effective than conventional coronary bypass surgery. It can be used for multivascular diseases.

关 键 词：冠状动脉搭桥术 微创 非体外心脏不停跳 

分 类 号：R654.205[医药卫生—外科学]