摘要
目的对比分析骨骼化或带蒂游离乳内动脉在冠状动脉旁路移植术中的应用效果,总结相关经验.方法回顾性分析2015年9月至2016年7月,在我院心胸外科采用骨骼化(77例)或带蒂(85例)游离技术获取左乳内动脉(left internal mammary artery,LIMA)行冠状动脉旁路移植术的162例患者的临床资料.所有患者术中LIMA均端侧吻合到左前降支(left anterior descending,LAD).分析两组患者的LIMA获取时间、术中LIMA桥血流量、术中LIMA桥搏动指数PI、术后前3天每日胸腔引流量及术后随访1年时的LIMA桥通畅率.结果所有患者均顺利完成LIMA至LAD的冠状动脉旁路移植手术.骨骼化组获取LIMA的时间略长于带蒂组[(33.8±4.7)min比(26.6±4.1)min,P<0.05];但骨骼化组术中LIMA桥血流量明显优于带蒂组[(36.9±20.1)ml/min比(28.6±17.2)ml/min,P<0.05]而两组术中LIMA桥搏动指数无明显差异(3.1±1.2比2.9±0.8,P>0.05).骨骼化组术后前3天引流量均明显少于带蒂组(P<0.05).术后随访到1年时的LIMA桥血管通畅率为100%.结论骨骼化游离乳内动脉可安全、有效地应用于冠状动脉旁路移植术中,近中期效果满意.与带蒂游离乳内动脉相比,骨骼化组术中LIMA桥血流量更好,术后早期胸腔引流量也更少,但骨骼化组获取LIMA的时间略长.
Objective To compare and analyze the clinical effect of skeletonized versus pedicled internal mammary artery in coronary artery bypass grafting(CABG).Methods From September 2015 to July 2016,162 patients with coronary artery disease undergone CABG in our hospital were enrolled.The methods of harvesting left internal mammary artery(LIMA)included skeletonization(n=77)and pedicle preparation(n=85).All patients underwent end-to-side anastomosis of LIMA to the left anterior descending(LAD).After implantation of the LIMA,LIMA graft perfusion was measured with a flow probe.The harvesting time of LIMA,the blood flow and pulsatility index(PI)of LIMA,postoperative thoracic drainage and patency rate of LIMA were compared between the two groups.Results All patients successfully underwent CABG with LIMA to LAD anastomosis.The time of harvesting skeletonized LIMA was longer than the time of harvesting pedicled LIMA[(33.8±4.7)min vs.(26.6±4.1)min,P<0.05].The blood flow of LIMA in the skeletonized group was significantly better than that in the pedicled group[(36.9±20.1)ml/min vs.(28.6±17.2)ml/min,P<0.05],while there was no significant difference in the PI of LIMA between the two groups(3.1±1.2 vs.2.9±0.8,P>0.05).The thoracic drainage volume of skeletonized group was significantly less than that of pedicled group in the first three days after operation(P<0.05).The patency rate of LIMA was 100%at 1 year postoperatively during the follow-up.Conclusion Skeletonized LIMA could be safely and effectively applied in CABG with satisfactory early and mid-term outcomes.Compared with pedicled LIMA,skeletonized LIMA had much better blood flow and less thoracic drainage,but the time of harvesting skeletonized LIMA was longer.
作者
姜兆磊
梅举
汤敏
马南
刘浩
沈赛娥
丁芳宝
鲍春荣
JIANG Zhao-lei;MEI Ju;TANG Min;MA NanLIU Hao;SHEN Sai-e;DING Fang-bao;BAO Chun-rong(Department of Cardiothoracic Surgery,Xinhua Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200092,China;Department of Anesthesiology,Xinhua Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200092,China)
出处
《中国心血管病研究》
CAS
2020年第4期337-340,共4页
Chinese Journal of Cardiovascular Research
基金
国家自然科学基金项目(81570290、81600264)
上海市科研计划项目(19411963800)。
关键词
冠状动脉旁路移植术
乳内动脉
骨骼化
带蒂
Coronary artery bypass grafting
Internal mammary artery
Skeletonized
Pedicled
作者简介
通信作者:汤敏,E-mail:tangmin@xinhuamed.com.cn。
