双侧乳内动脉在冠状动脉搭桥中的应用

Application of bilateral internal mammary artery in coronary artery bypass grafting

目的 探讨双侧乳内动脉在冠状动脉搭桥中的应用及效果。方法 自 1 998年 1月到2 0 0 1年 3月 ,运用双侧乳内动脉连续为 51例患者行冠状动脉搭桥手术。所有患者均为男性 ,年龄36～ 65岁 (平均 49.9岁 ) ,48例患者为 3支病变 ,3例为左主干病变 ,37例术前有心梗 ,4例合并室壁瘤。 47例在体外循环下行冠状动脉搭桥手术 ,4例在非体外循环下行冠状动脉搭桥手术。 39例行左侧乳内动脉 (LIMA)到钝缘支、右侧乳内动脉 (RIMA)到前降支 ;9例行LIMA到前降支、RIMA到右冠状动脉手术 ;LIMA到前降支、RIMA到钝缘 3例。运用胃网膜右动脉或桡动脉行其他病变血管搭桥手术。 4例同时行室壁瘤切除。 1例行冠状动脉内膜剥脱。人均搭桥 3支。结果 手术早期死亡 3例(手术早期死亡率 5 .9% )。死亡原因 :1例术后围术期心梗导致低心排 ,1例顽固性心律失常 ,1例因脑栓塞在术后 40d死亡。 4例需主动脉球囊反搏支持。 2例术后出现切口感染 ,再次清创处理。随访2～ 39月 (平均 1 5 .5个月 ) ,患者均无心绞痛再次发作。B超检查显示双侧乳内动脉均通畅。 结论 双侧乳内动脉在冠状动脉搭桥中具有较好的应用效果 ,近期效果比较满意 ,远期效果尚待进一步随访。

Objective To evaluate the effects of application of bilateral internal mammary artery grafts in coronary artery by pass grafting (CABG). Methods From Jan.1998 to Mar.2001, 51 patients with coronary arteriosclerotic cardiopathy, all males, aged 36～65 (average 49.9 years), underwent coronary artery bypass grafting with bilateral internal mammary artery grafts. The pathologic change involved three branches of coronary artery in 48 cases and involved the left main trunk in 3 cases. 37 patients had the history of myocardial infarction. Four cases were complicated by left ventricular aneurysm. 47 cases were operated upon on pump and 4 off pump. Left ventricular aneurysmectomy was done in 4 patients and coronary endarterectomy in 1 patient. The patterns of anastomosis were as follows: right internal mammary artery (RIMA) to left anterior descending artery (LAD) and left internal mammary artery (LIMA) to obtuse marginal (OM) in 39 cases, LIMA to LAD and RIMA to right coronary artery (RCA) in 9 cases, and LIMA to LAD and RIMA to OM in 3 cases. Gastroepiploic artery and left radical artery were used in other bypass grafting. The average number of grafts used for each case was 3. Results There were 3 early operative deaths, with an early operative mortality rate of 5.9%. One patient died of low output syndrome due to perioperative myocardial infection, 1 patient died of refractory arrhythmia, and 1 patient died of cerebral accident 40 days after operation. Intraaortic balloon pump was used in 4 cases post operatively. Mediastinal infection occurred in 2 patients. The patients were followed up for 2 to 39 months (average 15.5 months). During the follow up, no angina pectoris occurred and ultrasonography showed that the bilateral internal mammary artery grafts were unobstructed in all patients. Conclusion Bilateral internal mammary artery grafts can be applied effectively in CABG with a good short term effect, especially for young patients.