非体外循环下冠状动脉搭桥术

Off-Pump Coronary Artery Bypass Grafting

探讨非体外循环心脏跳动下冠状动脉搭桥术的适应症和手术方法,并报告54例非体外循环下的冠状动脉搭桥术.手术方法是在静脉和吸入复合全麻及常温下进行,54例患者中采用胸部正中切口46例、左前外小切口6例、右前外小切口2例.单支病变8例,双支病变4例,三支病变42例,左主干病变4例.本组54例患者总搭桥168支,平均搭桥3.17支,其中左乳内动脉搭桥43例,右乳内动脉搭桥2例,双乳内动脉搭桥9例,全动脉化搭桥17例,桡动脉搭桥7例,急诊搭桥2例,同时行左心室室壁瘤缝扎术1例.全组无手术死亡,平均手术时间189min,平均带气管插管时间为术后5.5h,43例患者(81%)未输血.无围术期心梗,术后患者心绞痛症状均有缓解或消失.本文结论是非体外循环心脏跳动下冠状动脉搭桥术安全、可行,手术适应症广,特别适合老年及心、肺、肾功能不全的患者,并可减少手术创伤及体外循环的并发症,可减少输血或不输血,缩短在ICU的时间,降低医疗费用等.

The article reviewed 54 cases with off_pump normothermic coronary artery bypass grafting (OPCAB) and explored its indication and surgical technique. OPCAB was performed on these 54 cases. Forty six cases received operation through middle sternotomy, 6 cases through left anterior minimal invasive thoracotomy and 2 cases through right anterior minimal invasive thoracotomy. Of all 54 cases, single_vessel diseases in 8, double_vessel diseases in 4, three_vessel diseases in 42 and left main stem diseases in 4. There were total 168 grafts in this group and an average of 3.17 grafts was performed on per patient. Left internal mammary artery (IMA) were used in 43 cases, right IMA in 2, and bilateral IMA in 9. Complete arterial myocardial revascularization (CAMR) was performed in 17 cases and radial artery was used in 7 cases. Emergent OPCAB was performed in 2 cases and 1 case combined with left ventricular aneurysm. The result was of no operative death. The average time of operation and tracheal incubation were 189 minutes and 55 hours respectively, blood transfusion was not required in 43 cases (81%). There was no perioperative myocardial infarction and all cases remained in good conditions after operation. Conclusion of OPCAB is minimal invasive surgery and can reduce the complication of cardiopulmonary bypass. In addition, it can reduce the volume of banked blood, shorten ICU stay time and decrease medical costs. OPCAB is a safe and feasible operation, especially for elder patients and those with heart, lung and renal dysfunction.