微创冠状动脉搭桥术51例报告

目的　探讨微创冠状动脉搭桥术的临床实用价值。　方法　自 1998年 8月至 1999年11月 ,5 1例冠心病患者接受微创非体外循环心脏不停跳冠状动脉搭桥术。男性 42例 ,女性 9例 ,年龄 39～ 80 (平均 6 4)岁 ,陈旧性心肌梗死 35例 ,糖尿病 9例 ,左室射血分数 2 0 %～ 72 % ,平均 (5 3±13) %。采用前胸正中切口 ,应用CTS、Octopus、USSC血管固定器 ,搭桥 1～ 4(平均 2 7)根 ,应用左胸廓内动脉 35例、右胸廓内动脉 1例 ,双侧胸廓内动脉 15例 ,桡动脉 3例。　结果　手术死亡 1例 ,病死率 1 9%。平均ICU时间 1 2d ,术后平均 6d出院。平均胸腔引流量和输血分别为 415ml和 16 0ml。随访平均 14个月 ,所有患者心绞痛症状消失 ,活动量增加。 2例患者术后 2个月随访冠脉造影 ,吻合口满意率 10 0 %。　结论　微创冠状动脉搭桥术安全、经济、有效 ,适用于体外循环高危患者 ,并可应用于多支血管病变 ,值得推广应用

Off pump coronary artery bypass grafting in 51 cases

OBJECTIVE: To study the cost-effective minimal invasive coronary bypass surgery which decreases the complication associated with cardiopulmonary bypass, alleviates postoperative pain, and promotes recovery. METHODS: From August 1998 to November 1999, fifty-one patients underwent minimal invasive coronary bypass surgery with off pump technique. Age range was from 39 to 80 years (average 64). Thirty-five patients suffered from myocardial infarction and nine patients diabetes. Left ventricular ejection fraction was from 20%-72% (average 53%). All procedures were completed through medial sternotomy. Stabilizers of CTS, Octopus, and USSC were applied. The average graft was 2.7 per case. RESULTS: The operative mortality was 1.9%. The average ICU and hospital stay were 1.2 and 6 days, respectively. The average chest drainage and blood transfusion were 415 ml and 160 ml, respectively. Fifty patients survived from surgery. All survived patients had no symptoms of angina during the short-term follow-up (1 to 8 months). Two patients were followed up by postoperative coronary angiography, which showed a satisfactory anastomosis rate of 100%. CONCLUSIONS: Minimal invasive coronary bypass surgery is safe, cost-effective, and suitable for patients with high risk of extracorporeal circulation. It can also be used for multivessel disease.