大隐静脉顺行序贯式吻合法在非体外循环冠状动脉旁路移植术中的应用

目的 评价在非体外循环冠状动脉旁路移植术中应用大隐静脉顺行序贯式吻合法的临床效果.方法 对75例冠状动脉粥样硬化性心脏病患者行非体外循环下冠状动脉旁路移植术.左乳内动脉搭桥至前降支,其余各支靶血管以大隐静脉行序贯式搭桥,序贯吻合顺序原则上依次为对角支、回旋支（钝缘支）、左室后支、后降支.结果 全组病例均在非体外循环下完成手术.桥血管吻合数目共296个,平均（3.95±0.55）个/例.全组患者无死亡,无围术期心肌梗死.迟发性心包填塞1例,急性肾功能衰竭1例,上消化道大出血1例,均治愈.结论 非体外循环下采用＂顺行序贯式吻合技术＂行冠状动脉旁路移植手术,可减少主动脉吻合口,节约桥血管长度,并可最快恢复心脏供血,是一种快捷、安全的术式.

The application of great saphenous vein antegrade sequential anastomosis in off-pump coronary artery bypass grafting

Objective Evaluation the clinical effect of great saphenous vein antegrade sequential anasto- mosis in off-pump coronary artery bypass grafting. Methods 75 patients with coronary atherosclerotic heart dis- ease underwent off-pump coronary artery bypass grafting. Left internal mammary artery was anastomosed to left an- terior descending artery. The rest of target vessel adopts great saphenous vein antegrade sequential anastomosis with in order of diagonal branch, circumflex （obtuse marginal branch）, left ventricle and posterior descending artery. Results All cases were performed off-pump coronary artery bypass grafting successful without death or periopera- tire myocardial infarction. The number of graft is 296, mean （3.95＋0.55） one case. Complications set in three cas- es, tardive pericardia]- tamponade, acute renal failure and massive hemorrhage of gastrointestinal tract, respective- ly. Conclusion Antegrade sequential anastomosis, as a fast, safe procedure, decrease stoma on aorta, save the length of graft and restorate blood supply of myocardium quickly in off-pump coronary artery bypass grafting.