非体外循环下的冠状动脉旁路移植术——101例临床经验体会

Off-Pump Coronary Artery bypass Grafting:Experience in 101 Patients

目的 :探讨非体外循环下冠状动脉旁路移植术的手术方法及手术适应证 ,并评价其初步临床结果。 方法 :阜外心血管病医院 1996年 5月～ 1999年 12月完成非体外循环下的冠状动脉旁路移植术 10 1例 ,包括经正中切口非体外循环下的冠状动脉旁路移植术 (OPCAB)组 76例和经胸壁小切口非体外循环下的冠状动脉旁路移植术(MIDCAB)组 2 5例 ,其中 7例在胸腔镜辅助下获取内乳动脉。 结果 :OPCAB组 76例 ,旁路移植支数平均 2 .5 9支 ,无手术死亡 ,术后并发症包括 :心室颤动并使用主动脉球囊反搏1例 ,出血二次开胸 3例 ,胸部切口感染 2例 ,肺部并发症 2例 ,肾部并发症 1例 ;MIDCAB组 2 5例 ,旁路移植支数平均1.10支 ,无手术死亡 ,围术期心肌梗塞行再次旁路移植手术 1例 ,出血二次开胸 1例 ,胸部切口感染 1例。 结论 :对于选择的患者 ,非体外循环下 ,不停跳冠状动脉旁路移植术是一项安全、有效的术式。

Objective:To discuss the technique and the indication of off pump coronary artery bypass graft(CABG) technique and to evaluate the early result. Methods:Between 5/1996 and 12/1999,101 cases out of 1 500 CABG patients underwent CABG with beating heart and without cardiopulmonary bypass(CPB) in Fu Wai Hospital.Two kinds of operative accesses were used:Left anterior small thoracotomy and median sternotomy. Results:The sternotomy group included 76 cases.Mean number of grafts was 2 59±1 32(1-5).The material of grafts included left internal mammary artery(LIMA),RA and SVG.There was no procedural mortality.Ten patient had postoperative complications(13 2%);25 patients underwent thoracotomy and 1 06±0 25(1-3) grafts was used.Twenty four cases underwent graft bypass with LIMA.There were 4 cases with postoperative complication and no postoperative death. Conclusion:Off pump CABG is a safe and effective technique for selective patients with multi vessel coronary artery disease.The early result is acceptatle.