左胸小切口双侧乳内动脉双支全动脉化旁路移植联合经皮冠状动脉介入治疗冠状动脉多支病变1例报告

Minimally Invasive Coronary Bypass by Using Bilateral Internal Mammary Arteries Combine with Percutaneous Coronary Intervention for Multivessel Coronary Artery Disease: Case Report

本文报道1例60岁男性患者因急性胸痛就诊于我院,冠状动脉造影提示严重的冠状动脉三支病变,行微创冠状动脉旁路移植联合冠状动脉支架置入。通过左胸壁2个切口获取双侧乳内动脉并吻合成为Y型桥,然后分别将左、右乳内动脉远端吻合至前降支和中间支,手术时间306 min,术中出血50 ml,5 d后对右状动冠状病变进行冠状动脉介入支架治疗。术后第8天顺利出院。随访1个月患者未再有胸痛症状发作。我们认为对于复杂冠状动脉多支病变,这种杂交技术是微创而有效的。

A 60-year-old man was admitted with main complaint of chest pain on exertion. Coronary angiogram showed severe triple vessel disease. He underwent the hybrid technique of treatment through two left minithoracotomy incisions. Both internal thoracic arteries were harvested under direct vision. The left internal mammary artery（ LIMA） and right internal mammary artery（ RIMA）compositing Y grafts was constructed. The LIMA was anastomosed to the left anterior descending branch and the RIMA was anastomosed to the ramus intermedius. The operation time was 306 min. The amount of bleeding during operation was 50 ml. Five days later he underwent percutaneous coronary intervention at right coronary artery lesion successfully. He was discharged from hospital 8days after operation,and didn＇t complain of chest pain during fellow-up for one month. This technique demonstrates to be an effective and minimally invasive alternative to treat patients with multivessel coronary artery disease.