新型胸壁牵开系统与改良心脏稳定器在左胸小切口冠状动脉旁路移植手术中的应用  

Application of New-designed Chest Wall Lifting System and Modified Stabilizer in Left Small Thoracotomy Coronary Artery Bypass Grafting

作　　者：张鲁锋[1] 凌云鹏[1] 杨航[1] 鲍黎明[2] 杨威[2] 高卿[2] 崔仲奇[1] 

机构地区：[1]北京大学第三医院心脏外科,北京100083 [2]北京大学人民医院心脏外科,北京100044

出　　处：《中国微创外科杂志》2016年第3期193-196,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的总结经左前外侧胸部小切口在直视下获取左乳内动脉（left internal mammary artery,LIMA）行冠状动脉前降支旁路移植术的临床价值。方法 2012年5月~2014年6月在全身麻醉非体外循环下完成左前外侧胸部小切口冠状动脉旁路移植手术（minimally invasive direct coronary artery bypass,MIDCAB）200例。术中使用新型胸壁悬吊拉钩在直视下获取LIMA,应用改良稳定器在非体外循环下行前降支旁路移植。138例接受单纯左胸MIDCAB,62例接受左胸MIDCAB与冠状动脉介入相结合的分站式杂交。结果术后呼吸机使用时间（9.1±4.3）h,监护室停留时间（26.4±14.4）h。术后完全无输血156例,44例输红细胞2~6 U（中位数4 U）。1例（0.5%）发生围手术期心肌梗死,该患者出院后死于心力衰竭（死亡率0.5%）。106例术后1周造影复查,2例（2/106,1.9%）左乳内动脉桥闭塞,随即再行常规冠状动脉旁路移植手术,康复出院。197例随访2~26个月,（9.4±6.2）月,无死亡、心绞痛或心肌梗死发生。结论新型悬吊式乳内动脉牵开系统可以在直视下从第1肋上缘开始获取LIMA,使用改良心脏稳定器便于在心脏跳动下完成冠状动脉吻合,从而获得良好的临床效果。Objective To summarize the clinical value of left anterolateral small thoracotomy for left internal mammary artery（ LIMA） harvesting in coronary artery bypass grafting（ CABG）. Methods From May 2012 to June 2014,a total of 200 consecutive patients underwent minimally invasive direct coronary artery bypass（ MIDCAB） with left internal thoracic artery to left anterior descending artery（ LAD） via left anterior small thoracotomy by using chest wall lifting system and stabilizer. There were 138 cases of left anterolateral small thoracotomy CABG and 62 cases of hybrid coronary revascularization. Results The time of postoperative mechanical ventilation was（ 9. 1 ± 4. 3） hours and the length of ICU stay was（ 26. 4 ± 14. 4） hours. Blood transfusion of 2- 6 units（ median,4 units） was required in 44 cases. One patient developed postoperative myocardium infarction and died of heart failure after hospitalization. So the perioperative mortality was 0. 5%（ 1 /200）. Postoperative coronary angiography performed one week after surgery showed 2 of 106 patients developed graft occlusion,followed by conventional CABG via sternotomy. The two patients recovered well and were discharged. The remaining 197 patients were followed up for 2- 26 months,（ 9. 4 ± 6. 2） months,and there was no death,angina pectoris or myocardium infarction during the follow-up period. Conclusion The application of the new-designed chest wall lifting system could harvest LIMA under direct vision,and the combination with the modified stabilizer facilitates anastomosis of LIMA and LAD on a beating heart.

关 键 词：冠状动脉旁路移植术 非体外循环 小切口 

分 类 号：R654.2[医药卫生—外科学]