双侧骨骼化乳内动脉在冠状动脉旁路移植术中的应用  

Application of skeletonized bilateral internal mammary artery to coronary artery bypass grafting

作　　者：侯剑峰[1] 仲肇基[1] 李浩杰[1] 陈凯 樊红光[1] 畅怡[1] 高歌[1] 郑哲[1] 王小啟[1] HOU Jianfeng;ZHONG Zhaoji;LI Haojie;CHEN Kai;FAN Hongguang;CHANG Yi;GAO Ge;ZHENG Zhe;WANG Xiaoqi(Department of Cardiac Surgery,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100037,P.R.China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心脏外科,北京100037

出　　处：《中国胸心血管外科临床杂志》2020年第9期1059-1062,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：2018年国家重点研发计划项目(2016YFC13009009);首都临床特色应用研究(Z181100001718211)。

摘　　要：目的总结双侧骨骼化乳内动脉在冠状动脉旁路移植术(CABG)中应用的早期临床结果。方法回顾性分析2016年10月至2017年5月我院使用双侧骨骼化乳内动脉行CABG 62例患者的临床资料,其中男54例、女8例,平均年龄(56.8±6.0)岁。观察桥血管流量、围术期临床结果及冠状动脉CT结果。结果全组患者手术均在体外循环下完成,共完成124支乳内动脉吻合,同时使用大隐静脉吻合116支,平均远端吻合口数目(4.5±0.8)个。平均体外循环时间(116.4±22.9)min,平均主动脉阻断时间(83.0±18.3)min,平均呼吸机使用时间(20.8±21.3)h,住ICU时间(2.7±1.7)d。左侧乳内动脉桥平均流量(28.8±12.4)mL/min,右侧乳内动脉桥平均流量(32.8±13.8)mL/min,大隐静脉桥平均流量(41.5±21.5)mL/min;双侧乳内动脉桥血管平均流量差异无统计学意义(P=0.112)。全组患者无围术期死亡、心肌梗死、脑血管意外发生。1例男性患者胸骨愈合不良,行清创缝合后治愈。CT血管成像显示7支静脉桥、5支动脉桥吻合口远端显影浅淡,但仍通畅;1支静脉桥未显影,提示桥血管闭塞。结论在CABG中使用双侧骨骼化乳内动脉安全可靠,具有良好的早期结果。Objective To evaluate short-term clinical outcomes of skeletonized bilateral internal mammary artery(sBIMA) in coronary artery bypass grafting(CABG).Methods The clinical data of 62 patients(54 males and 8 females with an average age of 56.8±6.0 years) undergoing isolated CABG using sBIMA in our hospital from October 2016 to May2017 were retrospectively analyzed.The coronary graft flow,perioperative clinical outcomes and CT results were reviewed.Results All the operations were carried out under extracorporeal circulation.Anastomosis of 124 internal mammary arteries was performed and 116 great saphenous veins were used simultaneously with an average anastomosis site of4.5±0.8 for each patient.The cardiopulmonary bypass time was 116.4±22.9 min,aortic clamping time was 83.0±18.3 min,mechanical ventilation time was 20.8±21.3 h and ICU stay was 2.7±1.7 d.The graft flow of left internal mammary artery(LIMA),right internal mammary artery(RIMA) and great saphenous vein were 28.8±12.4 mL/min,32.8±13.8 mL/min and 41.5±21.5 mL/min,respectively.There was no significant difference in the graft flow between LIMA and RIM A(P=0.112).There was no perioperative mortality,myocardial infarction or cerebrovascular accident.Only one male patient suffered sternal complication and poor wound healing and then received debridement as well as suturing.Coronary CT angiography showed that distal anastomosis of 7 vein grafts and 5 artery grafts was demonstrated shallow and 1 vein graft was undemonstrated,suggesting occlusion.Conclusion CABG with sBIMA is a safe and reliable technique with excellent early results.

关 键 词：冠状动脉旁路移植术 双侧乳内动脉 骨骼化 外科手术 

分 类 号：R654.2[医药卫生—外科学]