微创多支血管冠状动脉旁路移植术临床效果及长期随访研究  

Clinical outcomes and long-term follow-up study of minimally invasive multi-vessel coronary artery bypass grafting

作　　者：张雨[1] 单江桂[1] 张路峥 薛松[1] ZHANG Yu;SHAN Jiang-gui;ZHANG Lu-zheng;XUE Song(Department of Cardiovascular Surgery,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200120,China)

机构地区：[1]上海交通大学医学院附属仁济医院心血管外科,上海市200120

出　　处：《中国心血管病研究》2025年第4期332-336,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的 分析经左胸小切口行不停跳冠状动脉旁路移植术(MICSCABG)治疗多支血管病变的有效性和安全性,随访临床结果。方法 回顾性分析2018年1月至2023年6月上海交通大学医学院附属仁济医院完成的左胸前外侧切口MICSCABG手术54例患者的临床资料,其中男42例、女12例,两支病变30例,三支病变24例。分析54例患者术后行冠状动脉CT血管造影(CTA)所示各桥血管通畅度与靶血管通畅度。结果 54例手术均顺利完成,全组无围术期死亡。术后因出血二次开胸1例,发生急性肾功能不全2例。术后平均气管插管时间(12.0±6.9)h,术后住ICU时间(28.8±12.9)h。术后6个月及每年患者至门诊随访,随访过程中发现近端吻合口狭窄1例,远端旁路血管闭塞2支。结论 微创左胸小切口MICSCABG治疗多支血管病变安全有效,随访结果满意。Objective To analyze the efficacy and safety of minimally invasive coronary artery bypass grafting(MICSCABG) via a left thoracotomy approach without cardiopulmonary bypass for the treatment of multivessel coronary artery disease and to follow up on clinical outcomes.Methods A retrospective analysis was conducted on 54 patients who underwent MICSCABG via a left anterolateral thoracotomy at Renji Hospital,Shanghai Jiao Tong University School of Medicine,between January 2018 and June 2023.The cohort included 42males and 12 females,with 30 cases of two-vessel disease and 24 cases of three-vessel disease.The patency rates of bypass grafts and target vessels were assessed using coronary CT angiography(CTA)within one year postoperatively.Results All 54 procedures were successfully completed without perioperative mortality.Postoperative complications included one case of reoperation for bleeding and two cases of acute renal insufficiency.The average duration of tracheal intubation was(12.0±6.9) hours,and the mean ICU stay was(28.8±12.9) hours.Patients were followed up at 6 months postoperatively and annually thereafter.During the follow-up period,one case of proximal anastomotic stenosis and two instances of distal graft occlusion were observed.Conclusion MICSCABG via a left thoracotomy approach is a safe and effective treatment for multi-vessel coronary artery disease,with satisfactory follow-up outcomes.

关 键 词：小切口 冠状动脉粥样硬化性心脏病 多支血管病变 不停跳 冠状动脉旁路移植术 

分 类 号：R654.7[医药卫生—外科学]