侧侧吻合术在序贯桥终末端细小靶血管缝合中的应用

目的 报道侧侧吻合术在序贯桥终末端与细小靶冠状动脉进行缝合时的临床应用，并观察其疗效。方法 自2012年10月至2013年3月北京安贞医院12例患者在非体外循环冠状动脉旁路移植术中应用侧侧吻合技术缝合序贯桥终末端的吻合口。其中男7例，女5例；年龄 （68.0±3.6） 岁。术中监测桥血管流量、搏动指数，术后复查超声心动图、心电图等指标，以评估其疗效。 结果 12例患者手术均成功，终末端吻合口流量 （21.1±8.6） ml/min，搏动指数为2.1±1.0。其中4例患者终末端吻合口的缝合方式临时由端侧吻合改为侧侧吻合，终末端吻合口流量分别由2 ml/min、7 ml/min、3 ml/min、5 ml/min增加至10 ml/min、32 ml/min、13 ml/min、23 ml/min，搏动指数分别由18.2、7.1、12.6、13.4改善至2.2、0.9、1.8、2.8。终末端的靶冠状动脉均为后降支，旁路移植血管（4.0±0.7） 支。术后7～10 d出院，无低心排血量综合征、恶性心律失常及围术期心肌梗死等不良事件发生。 结论 在将序贯桥终末端与细小靶冠状动脉进行缝合时，采用侧侧吻合技术进行缝合具有较高的通畅性，但在广泛推广应用之前，应对其远期疗效进行随访。

Side-to-side Anastomosis of Distal End of Sequential Vein Grafts to Small Target Arteries in Coronary Artery Bypass Grafting

Objective To describe a technique of side-to-side anastomosis of distal end of sequential vein grafts to small target arteries in coronary artery bypass grafting （CABG） and evaluate its clinical outcomes. Methods Twelve patients received side-to-side anastomosis at distal end of sequential vein grafts during off-pump CABG in Beijing AnzhenHospital between October 2012 and March 2013. There were 7 male and 5 female patients with their age of 68.0±3.6 years.To evaluate clinical outcomes of the technique,intraoperative graft blood flow,pulsatility index （PI） and postoperative echocardiography and electrocardiography were examined. Results All the 12 patients successfully received off-pump CABG. Mean graft flow and PI near the distal end anastomosis were 21.1±8.6 ml/min and 2.1±1.0,respectively. Four patients who initially received end-to-side anastomosis underwent revision into side-to-side anastomosis intraoperatively,whose graft flow increased from 2 ml/min,7 ml/min,3 ml/min and 5 ml/min to 10 ml/min,32 ml/min,13 ml/min and 23 ml/min respectively,and whose PI decreased from 18.2,7.1,12.6 and 13.4 to 2.2,0.9,1.8 and 2.8,respectively. Distal end of target arteries were all posterior descending artery. The number of bypass grafts was 4.0±0.7. All the patients were discharged 7-10 days postoperatively. None of the patients had low cardiac output syndrome,malignant arrhythmias or perioperative myocardial infarction in this study. Conclusion Side-to-side anastomosis of distal end of sequential vein grafts to small target arteries in off-pump CABG can produce higher anastomotic patency. Long-term follow-up outcomes of this technique are needed before widely clinical application.