胸腔镜辅助下微创冠状动脉旁路移植术的临床应用  

Clinical application of thoracoscopic minimally invasive direct coronary artery bypass grafting

作　　者：罗勇[1,2] 王伟[1,2] 袁武[1,2] 陈剑[1,2] 曹安强[1,2] 

机构地区：[1]成都市第三人民医院 [2]重庆医科大学附属成都第二临床学院心脏外科,610031

出　　处：《心血管外科杂志（电子版）》2015年第2期18-21,共4页Journal of Cardiovascular Surgery(Electronic Edition)

基　　金：四川省卫生厅基金课题(100025)

摘　　要：目的总结胸腔镜辅助下经胸壁小切口非体外循环冠状动脉旁路移植术（微创冠状动脉搭桥术）的临床应用和疗效，探讨其临床应用价值。方法2011年10月至2014年12月，成都市第三人民医院有28例患者接受胸腔镜辅助下冠状动脉旁路移植术，其中单纯左前降支血管病变9例，包括左前降支严重肌桥病变3例；两支冠状动脉血管病变8例；三支冠状动脉血管病变11例，合并有左主干狭窄50％以上2例。经左前胸小切口胸腔镜辅助心脏不停跳下行左乳内动脉至左前降支及对角支冠状动脉旁路移植术。结果术中游离乳内动脉失败1例中转正中切口，其余27例患者胸腔镜辅助下胸壁小切口顺利游离左乳内动脉，共搭桥29支，其中多支血管病变的18例非左前降支病变血管术后5～7d行经皮冠状动脉介入治疗。术后呼吸机辅助（4．5±2．2）h，2例术后于手术室拔除气管插管。平均ICU时间（18．0±9．5）h，术后平均住院时间（9．5±3．0）d。住院期间无再次手术病例，无围术期心肌梗死，死亡1例。随访1～36个月，无严重心绞痛，无心肌梗死发生，无再次手术病例。结论胸腔镜辅助微创冠状动脉旁路移植术能很好地游离乳内动脉，其安全、有效，近、中期疗效良好。Objective To summarize the clinical experience and effect of thoracoscopic minimally invasive direct coronary artery bypass MIDCABG. Methods From grafting （ MIDCABG）, and investigate October 2011 to December 2014,28 the value of clinical application of thoracoscopic patients underwent thoracoscopic MIDCABG （ 9 cases with one-vessel CAD, 3 cases with coronary myocardial bridge;8 cases with two-vessel CAD;11 cases with three-vessel CAD, 2 cases with left main CAD）in the Third People＇s Hospital of Chengdu. The thoracoscopic MIDCAB was performed by the left thoracic micro-incision for bypassing the left internal mammary artery（LIMA） to the left anterior descending artery （LAD）and the diagonal branch artery. Results The LIMA was easily dissociated assisted with thoracoscope ,except one case failed and replaced midline incision,29 grafts were carried out on the 27 patients,18 cases with multi-vessel lesion were performed by percutaneous coronary intervention on 5-7 days after MIDCABG. The average mechanical ventilation time was （4. 5 ± 2.2 ）hours, 2 patients were extubated in the operating room;the time staying in the intensive care unit averaged （18.0 ± 9.5 ）hours and hospital stay （9.5 ± 3.0 ） days. There was no reexploration or perioperative myocardial infarctions, 1 patient died in hospital. The patients were followed up for 1 to 36 months, there was no severe angina, myocardial infarctions, or reoperation. Conclusion The LIMA could be preferably dissociated assisted with thoracoscope. The thoracoscopic MIDCABG is safe and effective. The early metaphase clinical result is good.

关 键 词：冠状动脉旁路移植术 非体外循环 胸腔镜 外科手术 微创性 

分 类 号：R654.2[医药卫生—外科学]