胸腔镜辅助与前正中开胸非体外循环下冠状动脉旁路移植术乳内动脉桥猪模型的对比研究

Comparative study of the left internal mammary artery bypass graft between off-pump video-assisted coronary artery bypass graft and median thoracotomy operation in pig model

目的建立一种能模拟胸腔镜辅助非体外循环下冠状动脉旁路移植术乳内动脉桥的家猪模型,与前正中开胸手术进行对比研究。方法 16头家猪,随机分为2组,VACAB组为胸腔镜辅助组,采用胸腔镜辅助的方法行非体外循环下左乳内动脉-前降支(LIMA-LAD)旁路移植术,MTCAB组为前正中开胸组,采用前正中开胸的方法行非体外循环下左乳内动脉-前降支旁路移植术。比较两组手术时间、左乳内动脉(LIMA)游离时间,LIMA-LAD吻合时间,和不同时间点的血液监测指标:肌酸磷酸激酶(CK)、磷酸肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)。结果 VACAB组的手术时间、LIMA游离时间及LIMA-LAD吻合时间均较开胸组延长,且差异具有统计学意义。两组动物LIMA桥流量差异无统计学意义。两组之间CK、CK-MB、cTnI的差异无统计学意义。结论电视胸腔镜辅助非体外循环下冠状动脉旁路移植术是一种现实可行、效果良好的微创手术,采用动物模型进行VACAB训练有助于临床实践。

Objective To establish a pig model for simulating the left internal mammary arterybypass graft in video- assisted off-pump coronary artery bypass graft and compared with medianthoracotomy operation. Methods Sixteen pigs were randomly divided into two groups,VACAB Group（n=8）and MTCAB Group（n=8）. The former was performed video-assisted coronary artery bypass graftwith left internal mammary artery-left anterior descending（LIMA-LAD）. The animals in MTCAB Groupwere subjected to median thoracotomy for coronary artery bypass graft with LIMA-LAD. Operation time,harvest time of left internal mammary artery（LIMA）and LIMA-LAD anastomosis time were comparedbetween the two groups. And the levels of creatinine kinase（CK）,creatinine kinase isoenzyme（CK-MB）,and troponin I（cTnl）in different time points were recorded and compared between two groups.Results The operation time,the harvest time of LIMA and LIMA-LAD anastomosis time of VACABgroup were longer than that of group MTCAB,and the differences were statistically significant. There wasno significant difference in LIMA bridge flow between the two groups. The differences of CK,CK-MBand cTnI between the two groups were not statistically significant. Conclusion Video-assisted coronarybypass was a practical and effective method of minimally invasive direct coronary bypass graft. VACAB training by using the animal model is helpful to clinical practice