术前胸部CT细化评估在胸骨下段小切口微创冠状动脉旁路移植术中的应用  

Application of preoperative chest CT refinement evaluation in minimally invasive coronary artery bypass grafting through a small incision in the lower sternum

作　　者：张耀中 肖志斌[1] 张雅娉[1] 郭建中[1] 张永[1] Zhang Yaozhong;Xiao Zhibin;Zhang Yapin;Guo Jianzhong;Zhang Yong(Cardiac Surgery Department,Heart Center of Beijing Friendship Hospital Affiliated to 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,100050

出　　处：《中国心血管杂志》2023年第2期125-129,共5页Chinese Journal of Cardiovascular Medicine

摘　　要：目的探讨术前胸部CT三维重建细化评估在选择微创胸骨下段小切口行冠状动脉旁路移植术(MIST-OPCAB)中的应用价值。方法回顾性纳入2016年1月至2020年12月北京友谊医院心脏中心收治的行不停跳冠状动脉旁路移植术的200例手术患者。使用术前胸部CT进行胸骨、心脏及升主动脉等结构进行三维重建,测量胸骨后近端吻合空间的数据,进行术前评估,将适合行MIST-OPCAB患者分为:A组(完成胸骨下段小切口组,90例)、B组(拟行但未完成胸骨下段小切口组,62例)和C组(常规切口组,48例)。分析各组患者胸骨后近端吻合空间的参数,包括第2肋间胸骨平面至主动脉根部的垂直距离等数据及围术期临床指标等。结果A组的术前心功能Ⅲ级占比明显少于其他两组(3.3%比8.1%比10.4%,P<0.05),陈旧性心梗病人占比少于其他两组(2.2%比21.0%比31.3%,P<0.05),左室射血分数高于其他两组(66.1%比56.9%比62.9%,P<0.05),欧洲评分Ⅱ风险低于其他两组(5.3比7.2比7.9,P<0.05)。胸部CT三维重建参数显示,A组第2肋间胸骨平面至主动脉根部的垂直距离明显大于C组(32.8 mm和26.6 mm,P<0.05)。A组第2肋间胸骨平面至主动脉瓣口的垂直距离明显大于C组(70.6 mm和58.2 mm,P<0.05)。A组术中的胸骨下段小切口长度明显短于其他两组(P<0.05)。三组患者均顺利完成手术。A组的呼吸机使用时间(15.6 h比21.3 h比20.7 h)和住院时间(12.1 d比15.1 d比18.2 d)明显短于其他两组(均为P<0.05)。结论术前胸部CT细化评估有助于指导术中选择MIST-OPCAB治疗方式。Objective To assess the application value of preoperative three-dimensional(3D)reconstruction refined evaluation with chest CT in selecting minimally invasive small incision in the lower sternum for coronary artery bypass grafting(MIST-OPCAB).Methods A total of 200 patients who underwent non-stop coronary artery bypass grafting(CABG)in Heart Center of Beijing Friendship Hospital from January 2016 to December 2020 were retrospectively enrolled in this study.Preoperative chest CT was used to perform 3D reconstruction of sternum,heart,ascending aorta and other structures,measure the data of proximal anastomotic space,and to select patients suitable for CABG through small incision in the lower sternum.MIST-OPCAB patients were divided into three groups:Group A(completed small incision below the sternum,n=90),Group B(planned but not completed small incision below the sternum,n=62),and Group C(conventional incision group,n=48).The parameters of posterior proximal sternal anastomosis space in each group were analyzed,including the vertical distance from the second intercostal sternal plane to the aortic root,and clinical indicators were also analyzed.Results The proportion of preoperative cardiac function grade III in group A was significantly lower than that in the other two groups(3.3%vs.8.1%vs.10.4%,P<0.05),and the proportion of patients with old myocardial infarction was lower than that in the other two groups(2.2%vs.21.0%vs.31.3%,P<0.05).The left ventricular ejection fraction was higher in group A than that in the other two groups(66.1%vs.56.9%vs.62.9%,P<0.05).The risk of European score II was lower in group A than that in the other two groups(5.3 vs.7.2 vs.7.9,P<0.05).The chest CT 3D reconstruction parameters showed that the vertical distance from the second intercostal sternal plane to the aortic root in Group A was significantly higher than that in group C(32.8 mm and 26.6 mm,P<0.05).The vertical distance from the second intercostal sternal plane to the aortic valve orifice in group A was significantly greater th

关 键 词：胸骨下段小切口 胸部CT三维重建 非体外循环 冠状动脉旁路移植术 

分 类 号：R654.2[医药卫生—外科学]