左胸小切口冠状动脉旁路移植术30例分析

Left minimal incision in coronary artery bypass graft surgery:a report of 30 cases

目的：探讨左胸小切口冠状动脉旁路移植术（MIDCAB）的临床效果。方法：2013年10月至2014年10月,采用左胸小切口取左乳内动脉（LIMA）心脏不停跳冠状动脉旁路移植术30例。采用全麻、双腔气管插管,平卧位左胸抬高30°,左前外侧第4或第5肋切口,用特制牵开器（德国Fehling公司）牵开肋骨,游离乳内动脉,使用心脏固定器下行冠状动脉吻合。结果：全组患者无围术期死亡。术中出血量40~150m L,平均（85±32）m L。术后24h引流量0~1 325（285±262）m L。术后呼吸机辅助时间4~17h,平均（9.5±5.7）h。二次开胸2例。无切口感染。30例随访0.5~1年,心绞痛症状消失27例,明显减轻3例。结论：胸部小切口冠状动脉旁路移植术主要适用于心脏前壁冠状动脉尤其是前降支的再血管化,安全可靠,中期疗效好。使用特制牵开器行MIDCAB手术安全可行。

Objective： To evaluate the clinical effectiveness of Left minimal incision in coronary artery bypass graft surgery. Methods： From October 2013 to October 2014,30 patients were given MIDCAB via left anterior minithoracotomy with beating heart by using the left internal mammary artery（ LIMA）. a minimally invasive parasternal approach was emplyed under double-lumen endotracheal tube anesthesia. The patients were placed in recumbent position with left chest 30°raised. The exposure was provided by a small left anterior incision through the fourth or fifth intercostal space. A special retractor was utilized to brace the ribs. Results： There was no perioperative death. The intraoperative blood loss was 40-150（ 85 ± 32） m L. The post-operative blood loss was 0-1325（ 285 ± 262） m L in 24 h. The mechanical ventilation time was 4-16（ 9. 7 ± 5. 2） hours. 2 patients underwent a second thoracotomy. no wound infection happened. Follow-up observations for 0. 5-1years in30 patients found disappearance of symptoms in 27 patients and alleviation of symptoms in 2 patients. Conclusions： MIDCAB via left anterior small thoracotomy is suitable for the revascularization of anterior descending artery. The operative method has the advantages of small operation wound,rapid recovery,and good effect for a mid-and long- term therapy. MIDCAB via left anterior small thoracotomy can be performed safely by using the special retractor.