四种不同类型的微创小切口冠状动脉搭桥术

Minimally invasive direct coronary artery bypass:comparation of 4 different procedures

目的 分析四种不同类型的微创小切口冠状动脉搭桥术 (MIDCAB)的临床应用与特点。方法 总结在 6个单位实施 2 2例MIDCAB手术的临床资料 ,单支病变 19例 ,双支病变 3例 ;左心室射血分数平均为 (5 7.1±12 .3) %。四种类型手术分别为 :Ⅰ型 (全麻左前外侧LAST切口 ) 15例 ;Ⅱ型 (全麻电视胸腔镜辅助下的小LAST切口 ) 2例 ;Ⅲ型 (连续硬膜外麻醉清醒状态下LAST切口 ) 3例 ;Ⅳ型 (全麻胸骨中下段LESS切口 ) 2例。结果 所有MIDCAB手术均成功 ,同期行激光心肌血运重建术 1例。手术时间 110 .4± 13.2min。术后无死亡病例。 1例LESS切口愈合不良 ,无其他并发症。随访中有 1例术后 1年出现右冠状动脉狭窄 ,行介入治疗成功。其余患者均无心绞痛症状 ,心功能良好。结论 MIDCAB手术安全可靠。四种不同类型手术中 ,以Ⅰ型术式最常用 ,Ⅱ型术式微创效果最好 ,值得推广 ;Ⅲ型术式对技术水平要求高 ,而Ⅳ型术式最易于掌握。

Objective To analysis the clinical application and characteristics in 4 different types of minimally invasive direct coronary artery bypass (MIDCAB) surgery.Methods 22 cases of MIDCAB surgery were performed in a multi center programme from September of 1996 to April of 2002.There are 19 cases of single vessel disease and 3 cases of double vessel disease.The left ventricular ejection fraction was (57.1±12.3)%.The 4 types of procedures included left anterior small thoracotomy (LAST) with general anesthesia (TYPE Ⅰ),LAST procedure with LIMA takedown by thoracoscopy (TYPE Ⅱ);LAST procedure with continuous epidural anesthesia (TYPE Ⅲ);lower end sternal splitting (LESS) procedure with general anesthesia (TYPE Ⅳ).Results All MIDCAB procedures were successfully performed.The operation time was 110.4±13.2min.There was no death and no complication except that 1 case in TYPE Ⅳ procedure had a problem of delayed incision make up.1 patient received interventional therapy because of new lesion in right coronary artery 1 year after MIDCAB surgery.All the other patients were relieved from angina pectoris with satisfactory heart function.Conclusions MIDCAB surgery is safe and feasible procedure with good clinical results.In all 4 types of MIDCAB procedure,TYPE Ⅰ is most frequently used at present time and TYPE Ⅱ shows the best minimally invasive results that should be highly recommended.TYPE Ⅳ may be easy to perform,however TYPE Ⅲ asks for sophisticated skills.