肋间单一切口直视下微创多支OPCABG 50例

Minimally invasive coronary artery bypass grafting single-center experience in 50 patients with multi-vessel lesion

目的比较经左侧肋间小切口微创非体外循环冠状动脉旁路移植(OPCABG)术和正中开胸OPCABG治疗多支(两支及以上)冠状动脉病变临床效果,探讨经肋间单一切口多支OPCABG的围手术期效果和学习曲线。方法回顾性研究本中心2017年1月至2018年7月连续100例多支冠状动脉病变患者临床资料,按手术方案分为微创组和正中开胸组,每组50例。手术由同一术者执行,排除左心室射血分数<0.50和未使用乳内动脉的患者。分析患者围手术期临床资料,归纳手术方法和技巧,结果两组患者术前资料差异均无统计学意义(P>0.05)。组间比较,微创组在切口长度[(&2±1.2)cm对(25.3±3.5)cm,P=0.000]、术中洗涤出血量[(301±188)ml对(444±331)ml.P=0.01]、呼吸机使用[(16.18±5.90)h对(19.60±3.92)h,P=0.001]和监护室滞留[(19.19±6.85)h对(23.44±4.64)h,P=0.001]方面均有明显优势(P<0.05);在平均旁路移植血管数量、平均术后住院时间和围手术期并发症发生比例方面,两组差异均无统计学意义(P>0.05)。结论熟练掌握正中开胸0PCABG方法和技巧的医师,经学习曲线后行经左侧肋间小切口微创多支OPCABG安全可行。

Objective To compare the perioperative outcomes between patients who underwent multivessel off-punip coronary arterv bypass graft( OPCABG) via single left inlercoastal space and sternotomy, and to explore the perioperative outcomes and technigues about minimally coronary arten bypass grafting with multi-vessel lesion. Methods From January 2017 to July 2018, 100 patients were recruited using both left internal mammary artery and vein graft. They were divided into minimal invasive coronary artery bypass grafting( MICS) group and control group. Perioperative outcomes were analyzed and surgical techniques were summarized. Results There was no statistical difference in preoperative profiles, mean grafts and postoperative complications( P > 0. 05 ). Compared with control group, MICS group had statistical benefits in length of operation incision [(8. 2 ± 1.2 ) cm vs.(25. 3 ± 3. 5 ) cm, P = 0. 000 ], intra operative washed blood loss[( 301 ± 188 ) ml vs.(444 ± 331 ) ml,P =0. 01 ], postoperative venlilalion duration [(16. 18 ±5.90)h vs.( 19. 60 ± 3. 92 ) h, P = 0.()01 ] and length of ICU stay [(19. 19 ± 6. 85 ) h vs.(23.44 ± 4. 64) h, P = 0. 001 ]. Conclusion There is a learning process for surgeons to perform minimal invasive OPCABG via single left intercoastal space. Surgery is feasible for patients with multiple coronanr lesions. Mid and long term following up need to be studied.