骨骼化与带蒂乳内动脉在不停跳冠状动脉旁路移植术中的随机对照研究

Skeletonized versus pedicled left internal mammary artery in off-pump coronary artery bypass grafting:a randomized controlled trial

目的:探讨不同方法获取的乳内动脉(IMA)在不停跳冠状动脉旁路移植术(OPCABG)中的应用及早中期疗效的比较。方法:选取自2019年1月至2021年5月期间,本科行常规正中切口OPCABG术患者以数字随机分为骨骼化LIMA组(观察组)和常规带蒂LIMA组(对照组),所有LIMA均吻合于前降支(LAD),记录并比较两组患者的一般情况及术后早中期疗效。结果:观察组91例及对照组95例纳入本研究。全组患者均存活出院,无术后二次开胸止血、血液透析及气管切开、围术期心肌梗死、术后肾衰竭等严重并发症。观察组在LIMA长度及桥流量方面高于对照组[(20.12±1.52)vs.(17.43±1.59)cm,P<0.01;43(31,63)vs.35(23,48)mL/min,P<0.01],在术后24 h引流[300(200,400)vs.360(200,550)mL,P<0.01]、胸骨感染/哆开、乳糜胸及伤口慢性疼痛等方面低于对照组(1.1%vs.4.2%,0%vs.2.1%,6.6%vs.17.9%,P<0.05)。术后平均随访16个月,两组各有2例患者死亡,而再发心肌梗死、动脉桥闭塞、静脉桥闭塞及心绞痛分级等方面无显著差异。结论:骨骼化LIMA在OPCABG术中应用安全,术后早中期疗效满意。

Objective:To explore the effect of skeletonized or pedicled left internal mammary artery(LIMA) in off-pump coronary artery bypass grafting(OPCABG),and compare the short-term and middle-term clinical outcomes.Methods:From January 2019 to May 2021,patients underwent OPCABG were randomly divided in skeletonized LIMA group( clinical group) and pedicled LIMA group(control group).All LIMAs were anastomosed to left anterior descending artery(LAD).The operative data and post-operative outcomes were analyzed.Results:91 cases of clinical group and 95 cases of control group were included in this study.All patients were survived without reoperation for bleeding,hemodialysis,tracheotomy,perioperative myocardial infarction or postoperative renal failure.The clinical group had a greater length of LIMA and more LIMA-LAD graft flow than the control group[(20.12±1.52)vs.(17.43±1.59)cm,P<0.01;43(31,63)vs.35(23,48)mL/min,P<0.01].Postoperative 24-hour drainage[300(200,400)vs.360(200,550)mL,P<0.01] and sternal complications such as sternal infection or dehiscence,chylothorax,chronic pain were lower in clinical group than in the control group(1.1% vs.4.2%,0% vs.2.1%,6.6% vs.17.9 %,P<0.05).In 16 months of follow-up after surgery,two patients died in each group.No significant difference was found in recurrent myocardial infarction,graft occlusion or angina scores.Conclusions:Skeletonized LIMAs can be safely used in OPCABG,with satisfying short-term and middleterm outcomes.