冠状动脉旁路移植术中移植物桡动脉的制备技巧与早期结果

目的　探讨以移植物桡动脉作旁路移植物的冠状动脉旁路移植术中 ,桡动脉的制备技巧和早期结果。　方法　冠状动脉旁路移植患者 71例。术前以改良Allen试验评判桡、尺动脉通畅性。术中上肢外展 70°～ 80° ,肘窝以远 3cm至腕关节线内 2cm弧线形皮肤切口 ,将桡动脉连同伴行静脉和脂肪组织一并游离。分支以钛夹 (hemoclip)夹闭 ,于二夹之间剪断。严格避免夹镊桡动脉本身并尽量不用电灼。离断后腔内注入肝素化罂粟碱液并置于该液中备用。共制取桡动脉 72支 ,移植血管 79支。远端多吻合至后降支及钝缘支 ,近端均吻合至主动脉。术后常规应用钙阻滞剂 6个月。　结果　术后死亡 1例 ,病死率 1 4% ,死因与桡动脉无关。其余患者心绞痛消失 ,心功能显著改善。无筋膜室综合征或手臂缺血发生 ,未见围手术期心肌梗死。　结论　应用桡动脉行冠状动脉旁路移植术 ,简便、安全 ,手术效果好。严格的“免触”制备技术和术后应用钙通道阻滞剂是保证桡动脉良好功能的关键

Radial artery for coronary artery bypass grafting: operative techniques and early results

OBJECTIVE: To review the experience coronary artery bypass grafting (CABG) with the radial artery (RA) performed from June 1997 to December 1999. METHODS: A total of 71 patients received CABG in whom the performance of the radial and ulnar arteries were checked preoperatively with the modified Allen's test. A curvilinear skin incision was made from 3 cm distal to the cubital fossa to 2 cm before the proximal crease at the wrist. The RA was mobilized together with its satellite veins and surrounding fat tissues. Small branches were divided between hemoclips. Direct touching on the RA trunk was totally avoided and use of diathermy was minimized. A 1% papaverine solution of heparinized Ringer's was applied intraluminally into the free RA graft before it was stored in the same solution for later use. Seventy-two RAs were harvested and 79 distal anastomoses were made mostly to the posterior descending branches and the circumflex marginal branches. All the proximal anastomoses were directed to the aorta. Calcium channel blockers were routinely used for a period of 6 months postoperatively. RESULTS: There was 1 death for an operative mortality of 1.4%. The death was not caused by failure of RA graft. There was no compartment syndrome or hand ischemia. No perioperative myocardial infarction was observed. CONCLUSIONS: It is easy and safe to use the RA for CABG by which good results can be achieved. A'no-touch' harvesting technique and use of calcium-channel blockers are essential to the functioning of this conduit.