冠脉搭桥全原位动脉桥术式探索

Study of coronary artery bypass grafting with only in situ arteries

目的采用猪进行不停跳原位动脉桥冠脉搭桥（CABG）技术训练并探索几种原位动脉桥CABG的手术方法。方法采用体重60-70kg的猪6只，分为3组，每组2只，在全麻不停跳下行CABG。A组分别取左、右乳内动脉（uMA、RIMA），胃网膜右动脉（RGEA）行LIMA-旋支（LCX）端侧吻合，RIMA-前降支（LAD）端侧吻合，RGEA-右冠（rtCA）端侧吻合。B组分别取LIMA、RIMA，行LIMA—LCX侧侧吻合，再与LAD端侧吻合，RIMA—RCA端侧吻合。C组分别取LIMA、RGEA，行LIMA—LCX侧侧吻合，再与LAD端侧吻合，RGEA—RCA端侧吻合。结果手术顺利，动脉桥血流通畅，成功建立了三种全原位动脉桥CABG术式。结论三种全原位CABG方法均是可行的术式。行LIMA—LCX侧侧吻合后再与LAD端侧吻合，RIMA（或RGEA）-RCA端侧吻合是作者创立的全原位动脉桥CABG术式。

Objective Coronary artery bypass grafting （CABG） with in situ artery long-term patency rate is high. This research adopts the pigs to do CABG with off-pump, CABG technique training and exploration of several in situ artery operation methods. Methods The 6 pigs, weight of 60-70 kg, divided into 3 groups, 2 of each group, have been CABG with off-pump in general anesthesia： group A, The both internal mammary arteries （IMAs） and right gastroepiploic artery（RGEA） were harvested. Left internal mammary artery（LIMA）- left circumflex artery （LCX） end to side anastomosis. Right internal mammary artery （RIMA）-left anterior descending artery （LAD） end to side anastomosis; RGEA-right coronary artery （RCA） was end to side anastomosed. Group B, the IMAs were harvested, LIMA-LCX side-to-side anastomosis, and then to LAD end to side anastomosis; RIMA- RCA was end to side anastomosed. Group C, the LIMA and RGEA were harvested, LIMA and LCX side-to-side anastomosis, and then to LAD end to side anastomosis; RGEA-RCA was end to side anastomosed. Results Suc- cessfully established three kinds of in-situ arteries CABG surgery, the grafts are patency, then put to death the pigs. Conclusion CABG with all in situ Arteries is feasible. The LIMA and LCX side-to-side anastomosis, then to anterior descending branch end to side anastomosis. The RIMA （or RGEA）-RCA was end to side anastomosed are new feasible and the author created all in situ arteries CABG types.