经左胸后外侧切口进行非体外循环下二次冠状动脉旁路移植术的临床运用

Introduce experience of clinical application of a modified left posterolateral thoracotomy pathway in patients underwent off-pump redo-coronary artery bypass grafting( redo-CABG)

目的总结经左胸后外侧切口实施二次冠状动脉旁路移植术的临床应用与特点。方法我院自2014年7月～2016年3月共实施经左胸后外侧切口实施二次冠状动脉旁路移植术2例,使用普通肋骨撑开器,经左第五肋间进胸。从心尖部逐渐向心包内游离,分离原有初次手术造成的粘连面。合理暴露靶血管并判断选取远端吻合区域,使用大隐静脉或者小隐静脉作为血管桥,游离下肺韧带,侧壁钳夹取降主动脉为近端吻合口,从而进行二次冠脉血运重建。结果 2例均成功实施非体外循环心脏跳动下的冠状动脉旁路移植术,远端吻合口2～3个,平均手术时间182分钟。无住院死亡病例。目前随访尚无死亡及并发症报道。结论经左胸后外侧切口实施二次冠状动脉旁路移植术对某些二次开胸的冠心病病人是安全实用的选择,非体外循环方式下进行此类手术是可行的。

Objective Summarize the clinical experiences and features of performing redo Coronary artery bypass grafting(redoCABG)through a modified left posterolateral thoracotomy pathway.Methods From July 2014 to Mar 2016,two cases of patients were underwent redoCABG operation through the left fifth intercostal incision.Using a common rib spreader,enter the chest through the left fifth rib.Gradually dissociate from the apex of the heart into the pericardium and separate the original adhesive surface.The target vessels were reasonably exposed and identified as the distal anastomosis area.The great saphenous vein or small saphenous vein were used as the vascular bridge,the lower pulmonary ligaments were dissociated,and the descending aorta was taken by the lateral wall forceps as the proximal anastomosis,so as to conduct the redoCABG.Results Offpump redoCABG was performed on these two patients successfully.The mean operative time was 182 min,distal anastomotic sites were 2~3.No 30day mortality was reported and no operation related death or complications were reported during follow up.Conclusion Offpump redo CABG through a modified left posterolateral thoracotomy pathway was safe and available method for patients who need to receive reoperation therapy.