完全胸腔镜非体外循环冠状动脉旁路移植术的动物实验研究

目的探讨经胸壁3个1.5 cm小孔在完全胸腔镜下行非体外循环冠状动脉旁路移植术的操作技术的可行性。方法以4头25～60 kg的猪和72条8～24 kg的狗为研究对象。在胸壁打3个1.5 cm小孔,胸腔镜下,心脏跳动下,桥血管远端与左冠状动脉、前降支、对角支、回旋支等做连续吻合,近端与锁骨下动脉吻合。用11-0无损伤线连续缝合。结果 76只动物,共行冠状动脉吻合140个,每个吻合口的吻合时间20～72 min,(31.3±4.9)min,其中3个吻合口出现严重狭窄;左锁骨下动脉吻合52个,吻合时间18～58 min,(25.5±3.1)min,无严重狭窄。结论完全胸腔镜下非体外循环冠状动脉旁路移植术在动物实验中可行性。

Totally Thoracoscopic Coronary Artery Bypass Grafting: Animal Experiment

Objective To investigate the feasibility of totally thoracoscopic coronary artery bypass grafting through three 1.5-cm incisions on the chest wall. Methods Totally 76 animals, including 4 swines （25 - 60 kg） and 72 canines （ 8 - 24 kg） were enrolled into this study. Via three 1.5-cm ports on the chest wall, under a thoracoscope, with the heart beating, the internal thoracic artery （ITA） was localized and harvested from the first onto the fifth intercostals space. In parallel to these steps, the femoral artery was harvested. And then the left anterior descending coronary artery, diagonal branches, and left circumflex coronary artery were identified. Thereafter, the target vessel was exposed and incised, and the graft was sutured to the target vessel with an 11-0 running suture. The toe of the anastomosis was sutured first and carried in an out-in manner, and then, the lateral portion and the heel of the anastomosis were carried out in an outside-in manner. Results Anastomosis was made on totally 140 coronary arteries and 52 left subclavian arteries ; the mean operation time was （31.3 ± 4.9） min （20 - 72 rain） for a single coronary artery, and was （25.5 ± 3.1 ） min （18 -58 min） for the left subclavian artery. Severe anastomotic stricture was developed in 3 of the coronary arteries, but none of the left subclavian arteries. Conclusion Totally thoracoscopic coronary artery bypass grafting is feasible in animals.