经左胸前外侧小切口冠状动脉手术161例总结

摘要

目的 探讨经左胸前外侧小切口进行微创冠状动脉手术的可行性和疗效.方法 回顾性分析2010年7月至2018年2月期间在首都医科大学附属北京安贞医院进行经左胸小切口冠状动脉手术的161例患者的病历资料,其中男122例、女39例,平均年龄(60±10)岁,平均体质量(72±8)kg.2例右乳内动脉-右冠状动脉主干搭桥的病例选择右胸切口.共进行单支冠状动脉旁路移植术1 16例(包括普通单支病变70例、分站式冠状动脉杂交手术38例、Davinci机器人辅助冠状动脉旁路移植术4例、前降支肌桥3例、川崎病1例),两支冠状动脉旁路移植术33例,三支冠状动脉旁路移植术2例,冠状动脉肌桥松解术3例,冠状动脉瘘结扎术3例,一站式冠状动脉杂交手术4例.结果 围术期手术成功及顺利出院159例,死亡2例(1.2％),分别为1例一站式冠状动脉杂交术和1例微创两支冠状动脉旁路移植术患者.手术时间2～7h,平均手术时间(4.0±1.3)h;术后第1天引流量10～1 380 ml,平均引流量(354±318)ml;术后气管插管时间5 ～38 h,平均(14±7)h;输血患者33例,输血率为20.6％;术后住院时间4～11d,平均(6.0±1.8)d.术前左心室舒张末期直径(49 ±5)mm,术后为(48±6)mm,手术前后比较差异无统计学意义(P＞0.05).随访1个月～7年6个月,随访中绝大多数患者生活质量明显改善,生活满意度较高.结论 经左胸前外侧小切口进行冠状动脉手术创伤小,效果可靠,恢复快,在有相关手术适应证的患者中值得推广应用.%Objective To investigate the feasibility and efficacy of minimally invasive coronary artery surgery with left anterior lateral tboracotomy.Methords Clinical records of 161 cases of coronary artery surgery through left anterior lateral chest mini-incision from July 2010 to February 2018 in Beijing Anzhen Hospital,Capital Medical University were retrospectively analyzed (2 cases of right internal mammary artery-right coronary artery bypass had right chest incision).There were 122 males and 39 females;the mean age was (60 ± 10)years old;the mean body mass was (72 ± 8)kg.Surgical methods included 116 cases of one-branch coronary bypass (70 cases of single coronary lesion,38 cases of hybrid coronary surgery,4 cases of Davinci robot assisted coronary bypass,3 cases of anterior descending muscle bridge and 1 case of Kawasaki disease),33 cases of two-branch coronary bypass,2 cases of three-branch coronary bypass,3 cases of myocardial bridge lysis,3 cases of coronary fistula ligation and 4 cases of one-stop hybrid coronary revascularization.Results There were 2 deaths(1.2％),including 1 case of one-stop hybrid coronary revascularization and 1 case of two-branch coronary bypass;159 patients had successful surgery and recovered well.Operation time was (4.0 ± 1.3) h,2-7 h.Postoperative 1 d drainage volume was (354 ±318)ml,10-1 380 ml.Mechanical ventilation time was (14 ±7)h,5-38 h.Blood transfusion rate was 20.6％ (n =33).Postoperative hospitalization time was (6.0 ± 1.8) d,4-11 d.Left ventricular end-diastolic diameter after operation showed no significant difference compared to that before operation [(48 ± 6)mm vs (49 ±5) mm] (P ＞ 0.05).All patients recovered well during follow-up (1 month to 7 years and 6 months).Conclusion Minimally invasive coronary artery surgery through left anterior lateral chest incision is a safe,effective and quick recovery method in treatment of coronary heart disease.