胃网膜右动脉在非体外循环冠状动脉旁路移植术中的临床应用  

Clinical Application of Right Gastroepiploic Artery in Off-pump Coronary Artery Bypass Grafting

作　　者：张杨杨[1] 赵忠[2,3] 葛文[4] 赵胜[1] 夏宇[1] 袁彪[1] 

机构地区：[1]南京医科大学第一附属医院心胸外科,南京210029 [2]航天中心医院 [3]北京大学航天临床医学院心脏外科,北京100049 [4]上海中医药大学附属曙光医院心胸外科,上海201203

出　　处：《中国胸心血管外科临床杂志》2011年第4期305-308,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨胃网膜右动脉（RGEA）在非体外循环冠状动脉旁路移植术（OPCAB）中的临床应用。方法 2008年12月至2009年7月南京医科大学第一附属医院对38例冠心病患者采用RGEA行OPCAB治疗,根据在OPCAB中采用的移植血管不同将76例患者分为两组,RGEA组：38例,男36例,女2例;年龄65.87±6.29岁;采用常规移植血管加RGEA行OPCAB;对照组：38例,男35例,女3例;年龄66.68±6.24岁;采用左乳内动脉（LIMA）、桡动脉（RA）、大隐静脉（SV）作为移植血管行OPCAB。对两组患者的术中、术后临床资料进行分析、比较。结果两组患者手术顺利,无手术死亡,无二次止血、功能性胃排空障碍和严重感染等并发症发生。与对照组比较,RGEA组的手术时间延长（295.53±45.16 min vs.262.50±42.44 min,P=0.001）,吻合口总数（4.71±0.56个vs.5.29±0.92个,P=0.002）和术中血浆用量减少（194.74±186.30 ml vs.565.79±382.70 ml,P=0.000）;术后机械通气时间延长（1 398.82±1 349.94 min vs.985.39±170.30 min,P=0.036）,24 h胸腔引流量（394.71±205.36 ml vs.536.32±258.85 ml,P=0.008）、术后红细胞总量（1.67±1.48 U vs.2.81±2.48 U,P=0.010）、术后住院时间（12.47±3.20 d vs.15.47±9.31 d,P=0.035）均减少。随访72例,随访时间9~17个月,失访4例。随访期间两组患者无心肌缺血表现,RGEA组患者无胃部相关并发症发生。结论 RGEA是CABG良好的移植血管,手术技术要求较高,手术时间较长。Objective To investigate the clinical application of the right grstroepiploic artery（RGEA） in off-pump coronary artery bypass grafting（OPCAB）.Methods We retrospectively analyzed the clinical data of the 38 patients who underwent RGEA grafts for OPCAB between December 2008 and July 2009 in the First Affiliated Hospital of Nanjing Medical University.According to the difference of grafts,76 patients undergoing OPCAB were divided into two groups.In the RGEA group,there were 38 patients including 36 males and 2 females with an age of 65.87±6.29 years.For the patients in this group,OPCAB was carried out with RGEA and other routine conduits as grafts.The control group had 38 patients including 35 males and 3 females with an age of 66.68±6.24 years.They underwent OPCAB with left internal mammary artery（LIMA）,radial artery（RA）,or saphenous vein（SV） as grafts.The intraoperative and postoperative clinical data for patients in both groups were analyzed and compared.Results All operations were carried out without serious complications like reoperation for bleeding,functional delayed gastric emptying,or severe infection,and no operative death occurred.Compared with the control group,operative time in the RGEA group was longer （295.53±45.16 min vs.262.50±42.44 min,P=0.001）,the number of anastomotic stomas was less（4.71±0.56 vs.5.29±0.92,P=0.002）,and less intraoperative plasma was consumed（194.74±186.30 ml vs.565.79±382.70 ml,P=0.000）.The 24 h drainage loss（394.71±205.36 ml vs.536.32±258.85 ml,P=0.008）,the blood cell consumption（1.67±1.48 U vs.2.81±2.48 U,P=0.010） and the postoperative hospital stay（12.47±3.20 d vs.15.47±9.31 d, P=0.035） were significantly lower in the RGEA group compared with those in the control group.Meanwhile,the time of postoperative mechanical ventilation time was longer in the RGEA group than that in the control group（1 398.82±1 349.94 min vs.985.39±170.30 min,P=0.036）.Seventy-two patients were followed up for a period from 9 to 17 months wit

关 键 词：非体外循环冠状动脉旁路移植术 胃网膜右动脉 超声刀 

分 类 号：R654.2[医药卫生—外科学]