冠状动脉旁路移植术后大隐静脉桥远期通畅率的临床研究

Clinical Study of Long-term Patency Rate of Great Saphenous Veins Transplanted by Coronary Artery Bypass Grafting

目的 从技术角度总结4例完全性大隐静脉序贯式冠状动脉旁路移植患者术后15年以上移植物通畅的经验。方法 回顾性分析1989年11月至1992年12月在我院行中低温体外循环下行冠状动脉旁路移植术4例，男3例、女1例，年龄40～58岁，平均48.3岁。术中自腹股沟向下取大隐静脉45～50 cm，采用双钳技术、降落伞式吻合法吻合近、远心端吻合口。常规行两条序贯式旁路移植术。术后6 h鼻饲阿斯匹林，出院后患者自行控制动脉硬化危险因素。结果 4例患者分别于术后15年、16年、18年及21年接受选择性冠状动脉造影，提示静脉移植物吻合口全部通畅，患者基本无症状存活近20年。结论 妥善处理静脉移植物，采用序贯式旁路移植术，保证移植物呈抛物线状及高质量的完成吻合是获得静脉良好远期通畅率的先决和必要条件。

Objective To summarize the experience of 4 patients with a great saphenous venous graft patency after 15 years of postoperitive great saphenous venous sequential aortic coronary artery bypass grafting. Method We retrospectively analyzed the clinical data of 4 patients accepted great saphenous vein aortic coronary artery bypass graft under moderate hypothermia cardiopulmonary bypass from November 1989 to December 1992 year. There were 3 males and 1 female with a mean age of 48.3 years ranging from 40-58 years. We harvested great saphenous vein under groin 45-50 cm. The proximal and distal anastomoses were performed with parachute technique under two clamps technique. Coronary artery bypass graft was performed by two sequential grafts routinely. Aspirin was given through nasal tube6 hours after operation. The risk factors of arteriosclerosis were controlled by patients themselves after discharge. Result Four patients received coronary angiography in 15, 16, 18, and 21 years after surgery and the grafts and both proximal and distal anastomoses were patent. The patients lived about 20 years without angina. Conclusion carefully dealing with the vein graft, taking sequential bypass grafting to guarantee parabolic curve and meticulous anastomosis are preconditional and necessary for long-term patency.