不同手术方式重建左前降支血运的效果  

Comparison of different methods to revascularize the isolated left anterior descending artery disease

作　　者：蔡俊锋[1] 邬祎程[1] 孙延军[1] 陈安清[1] 王哲[1] 赵强[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院心脏外科,200025

出　　处：《中华胸心血管外科杂志》2013年第4期209-211,232,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的比较使用非体外循环心脏不停跳冠状动脉旁路移植术（OPCAB）、微创小切口直视下心脏不停跳冠状动脉旁路移植术（MIDCAB）和机器人辅助冠状动脉旁路移植术（RA—CAB）3种不同方式行左前降支（LAD）血运重建的围手术期效果。方法2009年2月至2012年5月，接受单纯LAD血运重建患者102例，其中OPCAB组31例，MIDCAB组45例，RA—CAB组26例。MIDCAB手术方式为左胸小切口心脏不停跳冠状动脉旁路移植术，RA—CAB手术方式为daVinci机器人辅助左乳内动脉（u-MA）获取，左胸小切口心脏不停跳冠状动脉旁路移植术。结果3组患者在术中旁路血管流量、搏动指数和围手术期死亡、心肌梗死、脑血管意外、再次血运重建、严重心脑血管不良事件（MACCE事件）、肾功能衰竭、再次开胸止血、新发心房颤动、纵隔感染以及术后并发症率上均元显著差异。相比OPCAB，MIDCAB和RA—CAB能显著减少输血率（4．4％对32．3％，P〈0．05；7．7％对32．3％，P〈0．05），其中RA—CAB更能显著缩短术后住院天数[（8．8±3．2）天对（12．4±7．7）天，P〈0．05）]。MIDCAB与RA—CAB两组之间围手术期结果差异无统计学意义。结论MIDCAB和RA—CAB治疗左前降支血管病变安全、有效、可行，围手术期效果满意，比OPCAB能显著减少血制品的使用，RA-CAB更能大大缩短术后住院天数，具有创伤更小、恢复更快的优势。Objective Off-pump coronary artery bypass （OPCAB） , minimally invasive direct coronary artery bypass （MIDCAB） and robotic-assisted coronary artery bypass （RA-CAB） are all used to treat isolated left anterior descending artery （LAD） disease. The aim of this study is to compare the early outcomes after these three procedures. Methods From February 2009 to May 2012, 102 consecutive patients underwent revascularization of LAD. 31 patients were treated by OPCAB, 45 by MIDCAB and 26 by RA-CAB. Patients received steruotomy in the OPCAB procedures. The MIDCAB procedures were per- formed through a 10-em anterolateral muscle-sparing minithoracotomy. In the RA-CAB procedures, left internal mammary arter- ies （LIMA） were harvested with the aid of da Vinci surgical system and sewing of the anastomoses was performed under direct vision by a 3-cm anterolateral minithoracotomy. Results No significant difference was observed in graft flow, pulse index, re- nal failure, reoperation for bleeding, new onset of arterial fibrillation and deep wound infection between these three groups. There was also no significant difference in peri-operative mortality, major adverse cerebro-cardiovascular events （MACCE） be- tween these three groups. Compared with OPCAB, MIDCAB and RA-CAB significantly reduced the need of blood transfusion （4.4% vs. 32.3%, P 〈 0.05; 7.7% vs. 32.3%, P 〈0.05）. The patients receiving RA-CAB had shorter length of post- operative stay than whom receiving OPCAB [ （ 8.8 ± 3.2） days vs. （ 12.4 ± 7.7 ） days, P 〈 0.05 ） ]. There is no significant difference between the outcomes of MIDCAB and RA-CAB. Conclusion These findings indicated that MIDCAB and RA-CAB were feasible, effective and safe options for revascularization of isolated LAD disease. MIDCAB and RA-CAB showed the ad- vantage of less invasive and faster recovery, compared with OPCAB. Therefore, MIDCAB and RA-CAB should be the routine treatment for patients with isolated LAD disease. In some advanced centers, RA-CAB will be

关 键 词：冠状动脉硬化 冠状动脉旁路移植术 非体外循环 外科手术 微创性 机器人 

分 类 号：R65[医药卫生—外科学]