冠状动脉旁路移植术第二动脉桥血管的选择与评估

Selection and evaluation of the second artery conduit for coronary artery bypass grafting

冠状动脉旁路移植术是20世纪最杰出的外科成就之一。在其50多年的历史中,由于技术上的改进、心肌保护技术的应用、抗血小板和抗胆固醇药物的使用以及对桥血管选择的持续探究,患者的预后愈发理想。搭桥术中桥血管的功能仍然是影响预后最重要的因素,左乳内动脉由于其良好的通畅率而成为首选桥血管。然而,哪一条桥血管是可以成为“第二动脉桥血管”,仍然没有定论。争论包含很多方面,包括单支与双侧乳动脉移植物、槎动脉与大隐静脉移植物、右乳内动脉与挠动脉移植物:本文力求从解剖结构,功能评价和临床进展等方面对常用的动脉移植物进行全面概述,期望对冠状动脉旁路移植治疗方案的决策提供帮助。

Coronary artery bypass grafting is one of the most outstanding surgical achievements in the 20th century. Over the 50-year history patient outcomes have become excellent owing to technical refinements, myocardial protection, the use of antiplatelet and anticholesterol drugs and the continued search for better conduits. The performance of conduits used for bypass remains the most important prognostic factor, with the left internal mammary artery being the conduit of choice due to its excellent patency rates. There is, however. uncertainty with regards which conduit is the second best. Debate exists regarding various factors, including single vs bilateral mammary artery grafts, radial artery vs saphenous vein grafts, right internal mammary artery vs radial artery grafts. This article strives to give a comprehensive overview of the commonly used arterial grafts from the aspects of anatomical structure, functional evaluation and clinical progress, hoping to provide help for the decision-making of CABG treatment.