微创单支冠状动脉旁路移植术单中心505例经验  

Experiences and lessons of minimally invasive single coronary artery bypass grafting——505 cases report in asingle institute

作　　者：杨威[1] 陈彧[1] 陈生龙[1] 刘刚[1] Yang Wei;Chen Yu;Chen Shenglong;Liu Gang(Department of Cardiac Surgery,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院心脏外科,100044

出　　处：《中华胸心血管外科杂志》2021年第7期427-430,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的:探讨总结微创冠状动脉外科的术式选择、手术风险、术后并发症和相应治疗策略。方法:回顾性分析2005年11月至2019年3月期间北京大学人民医院心脏外科完成的小切口单支冠状动脉旁路移植术505例,其中男381例(75.4%),女124例(24.6%),年龄(61.39±9.79)岁。采用左前外侧肋间切口(MIDCAB)479例,机器人辅助MIDCAB(RA-MIDCAB)21例,胸骨下段小切口(DIMS-CABG)5例。记录并分析患者基本情况、手术数据、术后并发症和处理,以及术后随访结果。因MIDCAB病例占大多数,本研究主要分析MIDCAB组479例患者数据资料。结果:术后死亡1例,死因为心功能衰竭。因出血二次开胸6例,围手术期心肌梗死4例,卒中2例。7例因乳内损伤或胸膜粘连术中转正中开胸;另7例乳内动脉损伤,术中获取右乳内动脉或大隐静脉,续接左乳内动脉,完成血运重建。术后复查冠状动脉CT或造影81例,其中旁路移植血管闭塞8例(9.88%)。完成电话随访405例,患者均生存,生活质量良好,无心脑血管事件。结论:微创单支冠状动脉旁路移植手术是一种安全有效的治疗方案。术前详细评估、术中谨慎操作、充分的应急预案和合理的应对措施可进一步减少并发症发生。Objective To discuss the indication,risk,postoperative complications and corresponding treatment strategies of minimally invasive coronary surgery.Methods Reviewed 505 cases of minimally invasive single coronary artery bypass grafting completed in our center from November 2005 to March 2019,including 381 males(75.4%)and 124 females(24.6%).479 cases were via left anterior small thoracotomy(MIDCAB),21 cases were assisted by the Davinci system(RA-MIDCAB),and 5 cases were via distal mini-sternotomy(DIMS-CABG).Recorded and analyzed the patient's basic condition,surgical data,postoperative complications and treatment,and postoperative follow-up results.Results 7 cases of MIDCAB were converted into median sternotomy due to LIMA injury or pleural adhesion.Another 7 LIMA injury cases used RIMA or SVG anastomosed with LIMA to complete the revascularization.6 cases underwent reoperation due to bleeding.4 cases of postoperative myocardial infarction,1 of which dead.2 cases of stroke.81 patients followed up with coronary CT or arteriography.And there were 8 occlusive grafts(9.88%).405 patients completed telephone follow-up,all patients survived,good quality of life,no heart or cerebrovascular events.Conclusion Minimally invasive single coronary artery bypass grafting is a safe and effective operation.Preoperative detailed assessment,careful operation during surgery,adequate contingency planning and reasonable response measures can further reduce the occurrence of complications.

关 键 词：冠状动脉旁路移植术 微创 小切口 

分 类 号：R654.2[医药卫生—外科学]