摘要
目的总结微创左胸小切口冠脉搭桥术(MIDCAB)的临床经验,并与常规非体外循环心脏不停跳冠脉搭桥术(OPCAB)进行比较。方法选取合适病例共施行MIDCAB 21例,随机抽取同期OPCAB 30例进行对比研究,比较术前基本情况,观察术后引流量、呼吸机辅助时间、ICU时间、术后住院天数、二次开胸止血、围术期心梗、死亡率等,并随访3~24个月,观察有无心肌梗死或心绞痛发作。结果 MIDCAB组无1例死亡,术后呼吸机辅助时间、ICU时间、术后引流量、输红细胞量、胸腔积液例数、穿刺或引流处理例数、低心排例数、主动脉内球囊反搏(IABP)例数、肾功能不全例数、二次开胸止血例数、感染等发生率低于OPCAB组;随访3~24个月,乳内动脉(LIMA)桥均通畅,无1例发生心绞痛或心肌梗死。结论 MIDCAB创伤小,安全,效果可靠,适用于单纯前降支开口病变,或合并回旋支、右冠轻度狭窄(TIMI分级Ⅲ级),或回旋支、右冠病变可以支架处理的病例,值得推广。
Objective To summarize the clinical experience of the minimally invasive left chest incision coronary artery bypass surgery （MIDCAB） ,and to compare it with the routine off-pump coronary artery bypass grafting （ OPCAB） . Methods We selected the quali-fied 21 cases of MIDCAB and chose optionally 30 cases of OPCAB,and then comparatively studied the basic conditions before the treat-ment and observedthe volume of drainage after the surgery, the mechanical ventilation time, ICU time, the hospital stayafter the surgery, the second opening stanching, the perioperative myocardial infraction and the death rate. And the follow-up visit continued for 3 ？24 months and we observed if there was any case of myocardial infarction and angina pectoris or not. Results There was no death in the group of MIDCAB,the mechanical ventilation time after surgery,ICU time,the volume of drainage after surgery,the input of the red cell volume, the cases of the pleural effusion, the cases of puncture and drainage, the cases of low cardiac output syndrome, the cases of IABP, the cases of renal insufficiency, the cases of the second opening stanching and the infection ratewere all lower than those of the OPCAB group;the follow-up visit indicated that LIMAB bridge was unobstructed and there wasno case of death due to myocardial infarc-tion or angina pectoris. Conclusions The minimally invasive left chest incision coronary artery bypass surgery （ MIDCAB） is safe and reliable with little trauma,which can be applied to treat the pure anterior descending stenosis orthe stenosis complicated with the cir-cumflex artery and the moderate right coronary stenosis （TIMI Level III） ,or the cases in which the right coronary artery can be dealt by stent. MIDAB deserves popularization.
出处
《安徽医药》
CAS
2017年第1期106-109,共4页
Anhui Medical and Pharmaceutical Journal
关键词
冠状动脉旁路移植术
非体外循环
小切口
微创
杂交手术
Coronary artery bypass grafting
Off-pump
Small incision
Minimally invasive
Hybrid operation
