乳内动脉─冠状动脉旁路移植术──68例外科技术探讨

SURGICAL CONSIDERATIONS OF CORONARY ARTERY BYPASS GRAFTING (CABG) WITH INTERNAL MAMMARY ARTERY

本文报告６８例乳内动脉（ＩＭＡ）冠状动脉（冠脉）旁路移植术。手术均在中度低温体外循环下进行，心肌保护主要采用Ｓｔ．Ｔｈｏｍａｓ液经主动脉根部间断灌注，冠脉病变较重者加用冠状静脉窦持续逆灌。８例患者只用ＩＭＡ移植，６０例患者还同时用自体大隐静脉，应用左侧ＩＭＡ６６例，双侧ＩＭＡ２例，２例患者应用左侧ＩＭＡ作续贯式移植。ＩＭＡ与冠脉的吻合部位包括前降支６６例、对角支４例、右冠脉１例、回旋支１例。以冠脉吻合口计算，平均每例作２．８个吻合口。同期左室室壁瘤切除５例，冠脉内膜剥脱１４例。７例需安装主动脉内球囊反搏。术后３０天内死亡１例，手术死亡率１．４％，死亡原因为脑缺氧昏迷。手术存活的６７例中，６２例近期心绞痛症状消失，５例明显减轻；活动量均明显增加。远期结果有待进一步观察。结论：只要掌握好ＩＭＡ的游离和吻合技术，中国人应用ＩＭＡ作冠脉旁路移植术能取得满意的结果。

From Oct. 1986 to Feb. 1994, 68 patients had coronary artery bypass grafting (CABG) using internal mammary artary(IMA). There were 63 males and 5 females aged 29 to 67 years. 43 patients (64%)had stable angina, 36 (52%) showed old myocardial infarction on electrocardiogram. Cardiopulmonary bypass with moderate hypothermia and cold potassium crystalloid cardioplegia were employed. Left IMA graft was used in 66 patients, diagonal in 4, circumflex in 1,and right coronary artery in 1. Sequential left IMA graft was performed in two patients. Saphenous vein grafts combined with IMA grafts were used in 60 patients The mean number of distal anastomosis was 2. 8. Associated procedures included left ventricular aneurysmectomy in 5 patients, coronary endarterectomy in 14 patients. IABP was used in 7 patients. One patient died of stroke in the early postoperative period (within 30 days) and the operative mortality was 1. 4%. Of the 67 survivors, 62 were freed from angina and 5 had angina markedly improved postoperatively. Conclusion: IMA grafting can be performed safely and effectively in Chinese patients. The key points of doing IMA grafting lie in good mobilization and anastomosis techniques.