MIDCAB术治疗心肌桥与非心肌桥性左前降支病变的临床效果分析

目的 比较微创直视下冠状动脉旁路移植术（MIDCAB）治疗心肌桥与非心肌桥性左前降支（LAD）病变的临床效果.方法 2006年5月至2013年5月,37例冠心病患者在我院行MIDCAB手术,其中男性29例,女性8例,年龄48～76（62.9±6.8）岁.术前冠心病造影诊断：心肌桥致LAD重度狭窄12例（心肌桥组）,非心肌桥性LAD闭塞或LAD重度狭窄25例（非心肌桥组）.37例患者均经左胸前侧第4或第5肋间6 cm左右的小切口,非体外循环下完成LIMA-LAD吻合.结果 全组37例MIDCAB手术均顺利完成,无术中转为正中开胸手术,手术时间为117～143 min,围术期均未输血.术后呼吸机辅助通气时间为4～16 h,ICU停留时间为22～45 h,术后住院时间为6～10 d,全部患者术后无急性心梗和脑卒中等严重并发症及术后死亡,心肌桥组与非心肌桥组无明显差异（P＞0.05）.术后随访3～87 （27.59±19.15）个月,所有患者均做多层CT检查,LIMA-LAD吻合口通畅率为100％,全部患者没有心绞痛症状.结论 MIDCAB治疗心肌桥与非心肌桥性LAD病变可取得相同的优良效果.

MIDCAB for the treatment of left anterior descending coronary artery lesions of myocardial bridge or non-myocardial bridge

Objective To compare the clinical outcomes of minimally invasive direct coronary artery bypass （MIDCAB） for the treatment of left anterior descending coronary artery （LAD） lesions caused by myocardial bridge（MB） or non-myocardial bridge（non-MB）.Methods From May 2006 to May 2013,37 patients underwent MIDCAB in our hospital.There were 8 female and 29 male.Patients aged 28 to 76 years old （average 62.9±6.8years）.The preoperative coronary angiography showed MB of significant LAD disease in 12 cases （MB GROUP）,and non-MB of significant LAD disease in 25 cases （non-MB GROUP）.All 37 patients were performed off-pump MIDCAB with LIMA to LAD grafting through a minimally invasive approach from left anterior fourth or fifth intercostal space with a 6 cm incision.Results All patients successfully underwent MIDCAB.No patient need to transit to conventional sternotomy.The time of operation ranged from 117 to 143 minutes.The postoperative ventilation time ranged from 4 to 6 hours.The length of ICU stay ranged from 22 to 45 hours.And the postoperative hospital stay ranged from 6 to 10 days.No patient need blood transfusion.There was no early death and significant complications related to acute myocardial infarction or stroke in perioperation.At a mean follow-up of （27.59±19.15）months,multislice spiral CT showed that the patency rate of LIMA to LAD grafting was 100％,and no patient had angina symptoms.There was no significant differences of perioparative data or follow-up outcomes between the two groups （P＞0.05）.Conclusion MIDCAB can have similar and satisfactory results for the treatment of LAD lesions caused by MB or non-MB.