13例直视微创冠状动脉旁路移植术的临床总结

摘要

[目的]:初步总结直视微创冠状动脉旁路移植术(MIDCAB)的临床体会和近期临床效果.[方法]:自2010年9月21日至2011年11月22日,单组完成MIDCAB 13例,其中男性9例,女性4例；平均年龄(57.4±13.6)岁,范围34～77岁；平均体质量(68.1±8.3)kg；心胸比0.49±:0.04；体外循环下行冠状动脉旁路移植术(CABG)+二瓣置换术(MVR),机械瓣1例,非体外循环冠状动脉搭桥术(OP-CABG)12例.[结果]:本组病例围术期及出院后死亡为零；平均手术时间为(4.0±1.0)h,3～5.5 h；气管插管时间平均(12.1±4.8)h,3.5 ～19 h；ICU时间平均(15.7±3.5)h,7～20h；术后第一天引流量平均(378.5±187.8)mL,未输血患者:13例(100％)；术后住院时间平均(6.7±2.0)d,5～10 d；切口长度平均(7.5±1.4)cm,6～10.0 cm；出院时心功能1级3例、2级10例.[结论]:直视微创冠状动脉旁路移植术近期手术效果良好,安全性高；具有创伤小、切口美观、出血和输血少,无胸骨感染、并发症和病死率低等优点.%Objective:The aim of this study was to summarize primarily the clinical experience and the short-term clinical effect of the minimal invasive direct coronary artery bypass graft ( MIDCAB) procedure. Methods :From September 13, 2010 to November 22, 2011, 13 operations had been performed in our centre using MIDCAB, Among of which 9males and 4 females; mean age(57.4 ±13.6)years old; mean weight(68.1 ± 8. 3) kg. These operations included 1 MVR + CABG operation ( replacement with mechanical valve) with closed type extracorporeal circulation and 12 off-pump MIDCAB operations. Results: Hospital mortality was 0; median operation time was (4.0 ± 1.0) hours; median mechanical ventilation time was (12. 1 ± 4. 8) hours; median intensive care unit stay was (15. 7 ±3. 5) hours, median hospital slay post operative was (6. 7 ± 2. 0) days; Median draining volume was(378. 5 ± 187.8)mL in the first day after operation, No transfusion occurred in all patients; Median incision length was (7.5 ± 1.4) cm. When leaving hospital, 3 being of heart functional class I ,10 of class II. Conclusion;MIDCAB was associated with good operative effect in the near future and superior safety; Furthermore MIDCAB has minimally invasive, good cosmesis, less postoperative bleeding, fewer blood transfusion, as well as the absence of sternal wound infection. It may be safely performed on selected patients with low postoperative mortality and morbidity.