冠状动脉硬化性心脏病合并左锁骨下动脉严重狭窄非体外循环下同期手术的临床经验

目的探讨非体外循环冠状动脉旁路移植同时主动脉-锁骨下动脉旁路治疗冠状动脉硬化性心脏病(冠心病)合并锁骨下动脉重度狭窄的手术方法及效果.方法2003年1月～2004年5月,我院治疗须行冠状动脉旁路移植术同时合并左锁骨下动脉近端重度狭窄3例,术中先行主动脉-锁骨下动脉旁路,左乳内动脉获得满意的流量后,再行非体外循环冠状动脉旁路移植.结果手术时间210～340 min,平均283 min,出血量570～1 630 ml,平均963 ml.游离左乳内动脉后量杯测流量均＜5 ml/min,主动脉-锁骨下动脉旁路后量杯测流量均＞50 ml/min,乳内动脉远端与前降支吻合后流量仪测流量12～27 ml/min,平均20 ml/min.术后临床症状缓解,未发现冠脉-锁骨下动脉窃血综合征.3例随访3～6个月,平均5个月,无心绞痛发作.结论非体外循环冠状动脉旁路移植同时主动脉-锁骨下动脉旁路手术是治疗冠心病合并锁骨下动脉重度狭窄简单而有效的方法.

Simultaneous aorta - subclavian artery bypass in off - pump coronary artery bypass grafting for coronary artery disease combined with left subclavian artery stenosis

Objective To evaluate the safety and efficacy of simultaneous aorta-subclavian artery bypass in off-pump coronary artery bypass grafting(OPCAB) in the treatment for coronary artery disease combined with severe subclavian artery stenosis.Methods A total of 3 patients with coronary artery disease accompanying severe left subclavian artery stenosis proximal to the left internal thoracic artery(LITA) from January 2003 to May 2004 were included.The aorta-subclavian artery bypass was performed via median sternotomy.When enough blood flow of left internal thoracic artery was obtained,an off-pump anastomosis between the left internal thoracic artery and the left anterior descending coronary artery(LAD) was conducted.Results The operatron time was(210~)340 min(mean,283 min),and the blood loss was 570~1 630 ml(mean 963 ml).The flow volume obtained by measuring glass was <5 ml/min in the left internal thoracic artery after dissection and >50 ml/min in the aorta-subclavian artery bypass.The blood flow obtained by flowmeter was 12~27 ml/min(mean,20 ml/min) in the anastomosis of the pronimal left internal thoracic artery and the anterior descending coronary artery.Clinical symptoms were relieved after the surgery.No coronary-subclavian steal phenomenon occurred.Follow up examinations in the 3 patients for 3~6 months(mean,5 months) revealed no angina.[WTHZ] Conclusions Simultaneous aorta-subclavian artery bypass in OPCAB is a simple and effective treatment for coronary artery disease combined with severe subclavian artery stenosis.