胸骨下段正中小切口在冠状动脉旁路移植术中的应用

Application of lower median ministernotomy in coronary artery bypass grafting

目的总结162例胸骨正中下段小切口行冠状动脉旁路移植手术的经验。方法1998年4月～2003年6月,经胸骨下段正中小切口行冠状动脉旁路移植手术162例,包括体外循环下冠状动脉旁路移植术(coronaryarterybypassgrafting,CABG)77例,CABG联合心内手术13例,非体外循环CABG(off-pumpcoronaryarterybypassgrafting,OPCABG)72例。结果手术死亡1例(0.6%),再手术1例(0.6%),术后并发症9例(5.6%)。体外循环手术的主动脉阻断、体外循环及手术时间分别为(74.8±23.1)min、(113.6±31.3)min及(255.5±54.5)min。非体外循环手术时间(195.6±50.6)min。吻合口数目1～5个,(2.4±0.7)个。术后气管插管时间0～364h,中位数11h;恢复室时间1～28d,中位数3d;术后住院5～60d,中位数10d。胸腔引流量(607.2±443.0)ml,按体重计算为(8.6±6.0)ml/kg。38例输血,输血量(1161.3±741.2)ml。结论胸骨正中下段小切口行冠状动脉旁路移植手术创伤小,安全可靠;皮肤切口小;无须特殊器械,操作简单,可获得冠状动脉多支病变充分再血管化的效果,可同时进行其他心内手术。

Objective To review the experience of 162 cases of coronary artery bypass grafting (CABG) via a lower median ministernotomy. Methods CABG through a lower median ministernotomy was conducted in 162 cases from April 1998 to June 2003, including 77 cases of CABG under extracorporeal circulation, 13 cases of CABG concomitant with intracardiac surgery, and 72 cases of off-pump coronary artery bypass grafting (OPCABG). Results There were 1 case of surgery-related death (0.6%) and 1 case of re-operation (0.6%). Postoperative complications occurred in 9 patients (5.6%). In conventional CABGs, the aortic cross-clamp time, cardiopulmonary bypass time, and operation time were 74.8±23.1 min, 113.6±31.3 min, and 255.5±54.5 min, respectively. The operation time of OPCABG was 195.6±50.6 min. The number of anastomoses ranged 1~5 (2.4±0.7). The length of postoperative tracheal intubation was 0~364 h (median, 11 h). The length of postanesthesia care unit (PACU) stay and hospital stay were 1~28 d (median, 3 d) and 5~60 d (median, 10 d), respectively. The chest drainage volume was 607.2±443.0 ml, or 8.6±6.0 ml/kg. A blood transfusion was required in 38 cases, with a transfusion amount of 1161.3±741.2 ml. Conclusions A less invasive approach is possible in coronary artery bypass grafting via a lower median ministernotomy. This procedure provides satisfactory outcomes and good cosmetic results, during which a complete revascularization for multiple vessels and concomitant intracardiac operations are available.