微创左侧胸壁切口多支冠状动脉旁路移植术前降支平行侧侧吻合方式的尝试  

An attempt to applicate parallel side to side anastomosis in LAD by minimally invasive coronary artery bypass grafting via left lateral chest wall

作　　者：赵舟[1] 韩增强[1] 范桄溥[1] 王璇 廉波[1] 陈彧[1] ZHAO Zhou;HAN Zengqiang;FAN Guangpu;WANG Xuan;LIAN Bo;CHEN Yu(Department of Cardiac Surgery,Heart Center,People's Hospital of Peking University,Beijing 100044,China)

机构地区：[1]北京大学人民医院心脏中心心脏外科,北京100044

出　　处：《临床心血管病杂志》2022年第11期921-925,共5页Journal of Clinical Cardiology

基　　金：北京大学人民医院研究与发展基金(No:RDY2019-32)。

摘　　要：目的:初步探讨左胸前外侧小切口微创冠状动脉(冠脉)旁路移植(CABG)手术在前降支(LAD)靶血管上实施平行侧侧吻合的可行性和近期安全性。方法:选取2019年11月—2022年2月于我院心外科经左胸前外侧小切口微创CABG手术LAD实施侧侧吻合患者共计29例,其中男21例,女8例。平均移植(2.07±0.26)支。全部患者均采用原位左侧乳内动脉(LIMA)与桡动脉(RA)或大隐静脉(SVG)构成复合桥,并依次完成至前降支靶血管的侧侧吻合以及其他靶血管序贯吻合。通过对术中瞬时血流参数、围术期心肌酶水平以及术后1周冠脉CTA结果观察LAD侧侧吻合的围术期临床表现。结果:所有29例患者均按照原定计划顺利完成手术。术中对28例LIMA-LAD桥血管进行了瞬时流量仪测量,桥流量为(26.29±14.60)mL/min[对照组(29.72±20.93)mL/min,P=0.431]、搏动指数为2.93±1.02(对照组2.64±1.01,P=0.166)以及舒张期血供比例为71.21±10.09(对照组74.04±7.09,P=0.190),与对照组端侧吻合基线数据比较差异无统计学意义。术中1例患者未实施术中瞬时血流参数测定,但术后1周冠脉CTA显示复合桥血管通畅。本次研究中3例(10.3%)患者(6支桥)因各种原因未行术后1周冠脉CTA检查。其余26例冠脉CTA共发现桥血管闭塞2支,分别是1例为乳内动脉桥和SVG组成的复合桥第2站钝缘支吻合口闭塞,另1例为乳内动脉与RA组成的复合桥第2站后降支吻合口闭塞,桥血管闭塞率为3.77%;2例患者复合桥中第2站桥血管(RA-PDA)和第2、3站桥血管(RA-PL-PDA)显影略浅淡,但吻合口显示通畅,考虑存在“线样征”可能;1例患者复合桥第1站与第2站吻合口间桥血管显影浅淡,但与第1站和第2站吻合口位置显影良好,且断层观察显影良好,考虑与冠脉CTA成像相关。围术期心肌酶高于正常肌酸激酶同工酶界值10倍以上2例,即为上述出现桥血管闭塞人群(与对照组比较无统计学差异;P=0.110)。29例患者�Objective:To investigate the feasibility and short-term safety of LIMA bypassing to LAD using parallel side to side anastomosis by left lateral thoracic small incision for minimally invasive coronary artery bypass grafting.Methods:A total of 29 patients,including 21 males and 8 females,were selected from November 2019 to February 2022 in the department of Cardiology of PKUPH.In all patients,the composite grafts were formed by in situ left internal mammary artery(LIMA)and radial artery(RA)or great saphenous vein(SVG),and anastomotic method is parallel side to side anastomosis in LAD and sequential anastomosis of other target vessels were successively completed.The perioperative clinical manifestations of parallel side to side anastomosis in LAD were observed by measuring intraoperative transient parameters of graft blood flow,perioperative myocardial enzyme levels and CCTA results one week after operation.Results:All 29 patients underwent surgery as scheduled.Intraoperative flow parameters of graft of LIMA-LAD were measured by TTFM in 28 patients.TTFM parameters included MGF(26.29±14.60 mL/min vs 29.72±20.93 mL/min in the control group,P=0.431),pulse index(PI)(2.93±1.02 vs 2.64±1.01 in the control group,P=0.166)and DF(71.21±10.09 vs 74.04±7.09 in the control group,P=0.190),which showed no statistical difference from the baseline data of end-to-end anastomosis in the control group.Intraoperative TTFM was not performed in one patient,but CCTA showed that the composite graft was unobstructed one week after surgery.In this study,3 patients(10.3%)(6 Bridges)did not undergo coronary CCTA examination 1 week after surgery due to various reasons.In the other 26 cases of CCTA,two grafts occlusion were found,namely,occlusion of graft to OM in the second station of composite graft composed of LIMA and SVG in one case,occlusion of graft to PDA in the second station of composite graft composed of LIMA and RA in the other case,and the graft occlusion rate was 3.77%.The results of CCTA in two composite grafts showed the sec

关 键 词：非体外循环冠状动脉旁路移植术 侧侧吻合 微创 左胸前外侧小切口 

分 类 号：R541.4[医药卫生—心血管疾病]