左胸小切口多支动脉化冠状动脉旁路移植术64例的有效性和安全性分析  

Effectiveness and safety of multi-artery graft strategy for coronary bypass with small incision in the left chest for 64 patients

作　　者：宫一宸[1] 崔仲奇[1] 张鲁峰[1] 赵鸿[1] 傅元豪[1] 杨航[1] 吴松[1] 凌云鹏[1] GONG Yicheng;CUI Zhongqi;ZHANG Lufeng;ZHAO Hong;FU Yuanhao;YANG Hang;WU Song;LING Yunpeng(Department of Cardiac Surgery,Peking University Third Hospital,Beijing,100191,P.R.China)

机构地区：[1]北京大学第三医院心脏外科,北京100191

出　　处：《中国胸心血管外科临床杂志》2021年第2期191-197,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨左胸小切口冠状动脉旁路移植术多支动脉桥策略的安全性及有效性,为该技术推广提供证据。方法回顾性分析2015年12月至2019年11月北京大学第三医院心脏外科64例左胸小切口多支搭桥手术患者的临床资料。男54例、女10例,年龄36~77(61.1±8.7)岁。经第5肋间长5~8 cm左胸前外侧切口进胸,在非体外循环下进行手术,借助胸壁悬吊装置及心脏固定器,完成升主动脉近端吻合,前降支、回旋支及右冠状动脉系统的靶血管远端吻合等操作。移植血管数量2~4(2.3±0.5)支,其中45例患者移植2支,17例移植3支,2例移植4支;手术结合经皮冠状动脉介入治疗(PCI)杂交治疗3例,全动脉化旁路移植62例。术后7 d内复查冠状动脉造影评估旁路血管通畅率,随访记录主要不良心脑血管事件(MACCE)发生情况,通过Kaplan-Meier法计算免于发生MACCE率。结果无患者中转开胸手术,术中未应用主动脉内球囊反搏或体外膜肺氧合。术后切口愈合不良1例,再次手术2例(均为术后胸腔出血)。术后30 d内发生非致死性心肌梗死1例,无死亡。术后早期复查造影旁路血管总体通畅率为96.2%,前降支旁路通畅率为98.2%。随访12~60个月(中位随访时间28个月)。失访率7.8%(5/64)。36个月免于MACCE发生率为84.9%(95%CI 79.5%~90.3%)。结论左胸小切口多支冠状动脉旁路移植术可以实现完全再血管化及全动脉化搭桥,近期及中远期效果良好。Objective To investigate the safety and effectiveness of the multi-artery graf tstrategy for coronary bypass(MICS-CABG)with small incision in the left chest,and to provide experience for the promotion of this technique.Methods The clinical data of 64 patients with MICS-CABG in Department of Cardiac Surgery of Peking University Third Hospital from December 2015 to November 2019 were retrospectively analyzed.There were 54 males and 10 females,aged 36-77(61.1±8.7)years.The left lateral thoracic incision(5-8 cm)was made through the 5th intercostal incision,and the operation was performed under off-pump CABG.With the help of the chest wall suspension device and the heart fixator,the proximal anastomosis of the ascending aorta,anastomosis of the target vessels of the left anterior descending(LAD),left circumflex(LCX)and right coronary artery(RCA)systems were completed.The number of grafts was 2-4(2.3±0.5)including 2 grafts in 45 patients,3 grafts in 17 patients and 4 grafts in 2 patients.Three patients were treated with percutaneous intervention(PCI)hybridization and 62 patients were treated with total artery bypass graft.Coronary angiography was performed within 7 days after the operation to evaluate the graft patency rate.The incidence of major adverse cardiac and cerebrovascular events(MACCE)was recorded in the follow-up.The MACCE rate was calculated by Kaplan-Meier method.Results None of the patients was transferred to thoracotomy and no intra-aortic balloon counterpulsation(IABP)or extracorporeal membrane oxygenation(ECMO)was used during the operation.Incision infection was in 1 patient and reoperation in 2 patients(all were postoperative hemorrhage).Within 30 days after surgery,MACCE occurred in 1 patient,including 1 patient of non-fatal myocardial infarction.The overall patency rate of angiography bypass was 96.2%,and the patency rate of anterior descending branch bypass was 98.2%.Follow-up was performed from 12 to 60 months(median follow-up time was 28 months).The loss rate was 7.8%(5/64).The incidence of MAC

关 键 词：冠状动脉分流术 微创性手术 全动脉化搭桥 主要心脑血管不良事件 冠状动脉造影 

分 类 号：R654.2[医药卫生—外科学]