近端升主动脉CT三维重建在胸骨下段小切口非体外循环下多支冠状动脉旁路移植的临床应用  

Clinical application of three-dimensional CT reconstruction of proximal ascending aorta in multi-vessel off-pump coronary artery bypass with ministernotomy

作　　者：肖志斌[1] 张雅娉[1] 郭建中[1] 李殿坤 李莹莹[1] 张婷婷[2] 杨正汉[2] 张永[1] XIAO Zhi-bin;ZHANG Ya-ping;GUO Jian-zhong(Department of Cardiac Surgery,The Heart Center,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院心脏中心-心外科,北京100050 [2]首都医科大学附属北京友谊医院放射科,北京100050

出　　处：《临床和实验医学杂志》2019年第3期311-315,共5页Journal of Clinical and Experimental Medicine

基　　金：北京市自然科学基金(编号:7182042);心血管疾病精准医学北京实验室资助项目(编号:PXM2017_014226_000037);首都医科大学附属北京友谊医院科研启动基金(编号:yyqdkt2016-3)

摘　　要：目的使用近端升主动脉CT三维重建参数评估胸骨下段小切口完成非体外循环心脏不停跳下冠状动脉旁路移植(MIST-OPCAB)的近端吻合空间,完成多支病变的完全再血管化。方法对2015年1月至2017年5月首都医科大学附属北京友谊医院收治的行MIST-OPCAB的250例手术患者进行回顾性研究,使用术前胸部正侧位X线片和近端升主动脉CT三维重建的相关测量参数以及术前超声心动图、冠状动脉造影结果进行术前评估,选择适合行胸骨下段小切口的冠状动脉旁路移植患者。研究对象分组:(1)小切口组(即A组),112例MIST-OPCAB手术患者;(2)常规切口组,138例常规切口OPCAB患者。常规切口组再分为B组(CT参数适合行小切口手术,其它条件不适合行小切口手术)和C组(CT参数不适合行小切口手术)。比较三组患者升主动脉CT三维重建参数,观察桥血管分布及手术结果。结果小切口组112例,常规切口组138例,小切口组的左室射血分数(LVEF)大于常规切口组(66. 1±5. 5%vs. 63. 9±5. 8%,P <0. 05)。A组第2肋间胸骨平面至主动脉根部的距离明显大于C组[(32. 6±15. 8) mm和(26. 9±16. 5)mm,P <0. 05];小切口组112例患者均顺利完成手术,旁路移植2～4支,平均(2. 8±0. 6)支;近端1个吻合口108例,2个吻合口4例。远端靶血管分别吻合至前降支(LAD) 112例、后降支(PDA) 91例、钝缘支(OM) 56例及中间支(IR) 20例,对角支(Dx) 35例。使用左侧乳内动脉(LIMA) 111例,桡动脉(RA) 89例,大隐静脉(SVG) 105例。术后呼吸机辅助时间平均[19±22,(5,85)]h,重症监护室时间[60±20,(12,145)]h。结论升主动脉近端CT三维重建参数能够准确评估胸骨下段小切口完成非体外循环心脏不停跳下冠状动脉旁路移植,且远端靶血管血运重建临床效果满意。MIST与传统全程胸骨切口相比的优点是保存了部分胸廓完整性。Objective To explore the application of three-dimensional CT reconstruction parameters of proximal ascending aorta to evaluate the perfomation of multi-vessel off-pump coronary artery bypass with the performation of ministernotomy.Methods A retrospective study was conducted in 250 patients in this hospital during January 2015 to May 2017.Preoperative chest X-ray films,three-dimensional CT reconstruction parameters of proximal ascending aorta,echocardiography and coronary artery angiography were applied to evaluate the ministernotomy for patients underwent coronary artery bypass.These patients were divided into ministernotomy group(group A,n=112)and conventional sternotomy group(n=138),they were further divided into group B(CT parameters were suitable for ministernotomy,other conditions were not suitable for ministernotomy)and group C(CT parameters were not suitable for ministernotomy).The three-dimensional CT reconstruction parameters of ascending aorta were compared among these three groups.Grafts and surgical results were studted.Results There were 112 patients in ministernotomy group and 138 patients in conventional group A.The left ventricular ejection fraction was higher in ministernotomy group than that of conventional group(66.1±5.5% vs.63.9±5.8%,P<0.05).The vertical distance from second intercostal space to aortic root was significantly larger in group A than that in group C(32.6±15.8 vs.26.9±16.5,P<0.05).112 patients successfully underwent the operation with an average of 2.8±0.6(2~4)grafts.108 patients had 1 proximal anastomosis and 4 patients had 2 proximal anastomoses.The distal targeted vessels were 112 left anterior descending(LAD)branches,91 posterior descending arteries(PDA),56 obtuse marginal(OM)arteries and 20 intermediate ramus(IR),and 35 diagonal(Dx)branches,respectively.For 112 patients,111 left internal mamary artery(LIMA)grafts,89 radial artery(RA)grafts and 105 saphenous vein grafts(SVGs)were used during operation.After operation,ventilation time was [19±22,(5,85)] hours and the time

关 键 词：非体外循环心脏不停跳下冠状动脉旁路移植 胸骨下段小切口 近端升主动脉 CT三维重建 完全再血管化 

分 类 号：R654.2[医药卫生—外科学]