血管CT影像评估在微创心脏外科手术中的作用  

Role of vascular CT imaging in minimally invasive cardiac surgery

作　　者：丁士骜 梅举[1] 朱家全[1] 鲍春荣[1] 尹航[1] 

机构地区：[1]上海交通大学医学院附属新华医院心胸外科,上海市200092

出　　处：《中国心血管病研究》2017年第8期729-732,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的 探讨多层血管CT影像在微创心脏外科手术中的作用.方法 2013年6月至2016年6月,我科对拟行微创心脏外科手术（MICS）的176例患者术前行256层心脏螺旋CT扫描,将CT检查后排除行MICS的病例与成功行MICS的病例进行比较.结果 176例拟行MICS的候选患者均行术前CT检查,28例患者（15.9％）CT检查后有一个或多个指标提示不能行MICS而行正中开胸手术.148例患者（84.1％）CT检查后成功行MICS.MICS组的平均年龄为57岁,女性60例（40.5％）;非MICS组的平均年龄为65岁,女性为7例（25％）.所有行MICS患者（主动脉手术除外）均成功行升主动脉阻断,无灌注或周围血管并发症,无中风,有1例死亡（肺部感染急性加重）.结论 CT血管影像是MICS围术期中重要的评估手段.术前CT检查可以精确识别主动脉的钙化区域,弥补心彩超不能发现的不符合MICS的解剖和病理异常,减少围手术期并发症的发生,使MICS手术更安全,效果更可靠.Objective To examine the role of computed tomography （CT） in evaluating patients for MICS.Methods 176 consecutive candidates undergoing CT during preoperative evaluation for MICS aortic,mitral,tricuspid,atrial septal defect procedures from Jun 2013 to Jun 2016 were reviewed.The CT findings of patients excluded from MICS were compared against those successfully undergoing MICS.Results 176 MICS candidates underwent preoperative CT.28 （15.9％） had single or multiple CT findings precluding MICS and underwent sternotomy.148 （84.1％） had favorable CT findings and underwent MICS.The MICS group had a mean age of 57 years,with 60 women（g0.5％）;the non-MICS group had a mean age of 65 years,with 7 women（25％）.All MICS patients（except for aortic） had successful aortic cross-clamp.There were no perfusion or peripheral vascular complications.There was no stroke,one death（pulmonary infection Acute exacerbation）.Conclusion Vascular CT imaging is an important evaluation method in the perioperative period of MICS.Preoperative CT examination can accurately identify the aortic calcification area and find the anatomy and pathological abnormalities which Color Doppler ultrasound can not find before MICS.It reduce perioperative complications,make MICS surgery more safe and reliable.

关 键 词：微创心脏手术 CT血管影像 主动脉瓣 二尖瓣 三尖瓣 

分 类 号：R654.2[医药卫生—外科学]