非体外循环心脏不停跳下冠状动脉旁路移植术

目的:探讨非体外循环心脏不停跳下冠状动脉旁路移植术（off-fiump coronary　artery　bypass　grafting,OPCAB）治疗缺血性心脏病的临床经验和手术结果。方法:2001年～2002年完成冠状动脉旁路移植术共23例,手术均采用胸骨正中切口,在非体外循环心脏不停跳下完成,游离左侧乳内动脉均与前降支吻合,取大隐静脉及烧动脉与回旋支、后降支等其他部位血管吻合。冠状动脉吻合口和近端吻合口分别用7.0Prolene及6-0Prolene缝线连续法缝合。结果:全组手术无死亡,术后随访2个月～14个月,心绞痛症状均明显缓解,心功能Ⅰ级～Ⅱ级,术后心绞痛复发2例,给子扩冠、抗凝治疗后好转。术后并发右侧脑梗死1例,融栓、抗凝等治疗后病情好转。结论:非体外循环心脏不停跳下冠状动脉旁路移植术在缺血性心脏病的外科治疗中是一种理想、安全、有效的手术方法。

Off-pump coronary artery bypass grafting

Objective To explore the clinical experience and operative outcome of off- pump coronary artery bypass grafting (OP-CAB) in treating ischemic heart disease. Method From 2001 to 2002, twenty- three cases of OPCAB via midline sternotomy were per-fomed. These 23 cases of OPCAB were accomplished with anastomoses of the left thoracic artery-to-left anterior descending coronary artery and the saphenous vein and/or radial artery-to-circumflex and posterior descending coronary arteries etc. The proximal anastomoses in the aorta and the distal anastomoses of the coronary arteries in the heart were perfomed using 6-0 Prolene and 7-0 Prolene sutures respectively. Results No operative death occurred in all these 23 cases. During the period of 2 to 14 months postoperatively, significant relief of angina were achieved after bypass surgery. In two of these 23 patients undergoing OPCAB, recurrence of angina occurred but was improved by coronary vasodiktion and anticoagulation therapy. The postoperative complication of right cerebrovascular thrombus encountered in one OPCAB patient was effectively treated with antithrombolysis and anticoagulation therapies etc. Conclusion OPCAB is an optimal, save and effective operative method in the surgical therapeutic approach of ischemia heart disease.