摘要
目的总结非体外循环冠状动脉旁路移植术中升主动脉粥样硬化(ascending aortic athero-sclerosis,AAA)的临床处理经验。方法合并AAA行非体外循环冠脉搭桥术患者35例,5例联合应用左前外侧小切口不停跳冠脉搭桥和经皮腔内冠状动脉成形术(杂交技术);30例采用胸骨正中切口,其中9例行双侧乳内动脉原位移植,1例将大隐静脉桥近端吻合到无名动脉,12例以左乳内动脉为唯一的供血来源,其静脉桥或桡动脉桥吻合到左乳内动脉,8例应用"易扣"近端吻合辅助装置完成静脉桥的近端吻合。所有患者均未应用主动脉侧壁钳。结果35例手术均顺利完成,无死亡。术后主要并发症:二次开胸止血1例,肺部感染2例,切口感染1例,无围术期心肌梗死,无严重神经系统并发症。结论对于AAA患者,采用非体外循环冠脉搭桥结合杂交技术、主动脉不接触技术或近端吻合装置可以有效减少术后神经系统并发症,临床效果满意。
Objective To summarize the clinical management experience of ascending aortic atherosclerosis （AAA） in off-pump coronary artery bypass grafting （CABG）, Methods 35 cases with severe AAA were underwent off-pump CABG. Hybrid technique included integrated minimally invasive direct CABG and percutaneous transluminal coronary angioplasty was used in 5 cases, The median sternotomy incision was applied in 30 cases. Among them, no-touch aortic technique was performed in 22 cases： Bilateral internal mammary arteries were grafted in situ in 9 cases, The proximal greater saphenous vein graft was anastomosed to the innominate artery in one case. Left internal mammary artery （LIMA） was used as the only inflow in 12 cases, and greater saphenous vein or radial arery grafts were anastomosed to LIMA. Proximal anastomotic device （enclose） was applied in 8 cases to finish the proximal anastomosis of greater saphenous vein grafts. No aortic side-bite clamping was applied in all cases, Results All procedures succeed and no operative mortality occurred. The major postoperative complications included： reoperation for hemostasis （1 case）, pneumonia （2 cases）, and incision infection （1 case）, There was no perioperative myocardial infarction and serious neurological complication. Conclusion Off-pump CABG combined with hybrid technique, no-touch aortic technique or proximal anastomotic device can reduce the neurological morbidity and achieve a satisfied outcome for patients with severe AAA.
出处
《中国现代手术学杂志》
2008年第4期303-305,共3页
Chinese Journal of Modern Operative Surgery
