摘要
目的 总结17例胸骨下段正中小切口直视冠状动脉旁路移植术的经验,探讨其手术方法及适应证.方法 2009年4月至2011年7月,经胸骨下段正中小切口行冠状动脉旁路移植手术治疗单纯左前降支（LAD）病变17例,所有病例均游离左内乳动脉,不停跳下行内乳动脉-LAD 端侧吻合.结果 全组无手术死亡病例,手术时间（107.8±25.4）min,术后呼吸机应用时间2~22h,平均（6.7±10.3）h,ICU 驻留时间12~27h,平均（18.5±8.3）h,术后住院时间5~11d,平均（7.8±3.1）d,胸腔引流量（175±85）mL;13例患者未输血,4例输血量为200~400mL ;住院费用（4.0±1.2）万元.所有患者术后恢复良好,无严重并发症,均痊愈出院.术后随访时间4~24 个月,随访率100%,无晚期死亡病例,心绞痛症状完全消失率94.1%（16/17）.结论 胸骨下段正中小切口直视下冠状动脉旁路移植术创伤小,恢复快,疗效确切;切口美观;住院时间短,费用低;无须特殊器械,操作简单,值得在基层或初开冠状动脉旁路移植术单位推广.合理选择单纯LAD 病变病例更能突出胸骨下段正中小切口的优势及特点.
Objective To review our experience of minimally invasive direct coronary artery bypass grafting （MIDCAB） via a lower median ministemotomy and to explore the operative methods and indications. Methods MIDCAB through a lower median ministernotomy was conducted in 17 cases with isolated left anterior descending artery （LAD） lesions from April 2009 to June 2011. 14 patients had the opening or diffuse lesions of LAD. 3 patients had the restenosis after percutaneous coronary intervention. The left internal mammary artery was harvested to bypass LAD on the beating heart. ResuRs There was no perioperative mortality. The operative duration was （107.8±25.4） rain. The length of postoperative tracheal intubation, the length of postoperative ICU and hospital stays were 2-22h average （6.7±10.3） h, 12-27h average （18.5±8.3） and 5-11d average （7.8±3.1） d, respectively. Total average chest drainage was （175±85） mL. A blood transfusion was required in 4 eases with an amount of 200-400mL. The average costs were （40.0 ±10.2） thousand yuan. The incision on the chest wall was 6 to 12em long in all eases. All patients recovered well, without severe complications. All patients were followed-up for 4 to 24 months. There was no late death and 16 patients （94.1%） were free from angina. Conclusions A less invasive approach is possible in coronary artery bypass grafting via a lower median ministernotomy. It is safe, easy and doesn＇t require special operative instruments. Reasonable choice of isolated LAD lesions would show advantages and characteristics of MIDCAB better.
出处
《中国医药指南》
2012年第20期410-412,共3页
Guide of China Medicine
关键词
冠状动脉旁路移植术
胸骨
微创
Coronary artery bypass grafting
Sternum
Minimally invasive
