CAJ | 학술논문

目的：探讨胸部小切口冠状动脉搭桥术的临床效果。方法2002年1月～2013年1月采用胸部小切口取左乳内动脉（ left internal mammary artery，LIMA）心脏不停跳冠状动脉搭桥术66例。胸骨下段小切口59例，采用全麻、单腔气管插管，平卧位，倒“L”胸骨下段切口；胸骨旁小切口5例，采用全麻、双腔气管插管，平卧位左胸抬高30°，左前外侧第4或第5肋切口，用特制牵开器（法国圣骑士公司）牵开肋骨，游离乳内动脉，使用冠脉固定器下行冠脉吻合；2例胸腔镜辅助下完成乳内动脉与左前降支的吻合。结果66例均完成左乳内动脉至前降支的吻合，2例追加大隐静脉降主动脉至第一对角支的吻合。无围术期死亡。60例随访0．5～8年，（5．5±2．5）年，心绞痛症状消失42例，明显减轻24例。术后冠状动脉CT检查16例，冠脉造影12例，LIMA与左前降支（ left anterior descending， LAD）吻合口满意率100％，支架内再狭窄1例，大隐静脉桥血管闭塞1例。结论胸部小切口冠状动脉搭桥术主要适用于心脏前壁冠状动脉尤其是前降支的的再血管化，安全可靠，中期疗效好，在合并高危因素或常规冠状动脉搭桥术和经皮冠状动脉介入术效果不满意者中应用更佳。
목적：탐토흉부소절구관상동맥탑교술적림상효과。방법2002년1월～2013년1월채용흉부소절구취좌유내동맥（ left internal mammary artery，LIMA）심장불정도관상동맥탑교술66례。흉골하단소절구59례，채용전마、단강기관삽관，평와위，도“L”흉골하단절구；흉골방소절구5례，채용전마、쌍강기관삽관，평와위좌흉태고30°，좌전외측제4혹제5륵절구，용특제견개기（법국골기사공사）견개륵골，유리유내동맥，사용관맥고정기하행관맥문합；2례흉강경보조하완성유내동맥여좌전강지적문합。결과66례균완성좌유내동맥지전강지적문합，2례추가대은정맥강주동맥지제일대각지적문합。무위술기사망。60례수방0．5～8년，（5．5±2．5）년，심교통증상소실42례，명현감경24례。술후관상동맥CT검사16례，관맥조영12례，LIMA여좌전강지（ left anterior descending， LAD）문합구만의솔100％，지가내재협착1례，대은정맥교혈관폐새1례。결론흉부소절구관상동맥탑교술주요괄용우심장전벽관상동맥우기시전강지적적재혈관화，안전가고，중기료효호，재합병고위인소혹상규관상동맥탑교술화경피관상동맥개입술효과불만의자중응용경가。
Objective To evaluate the clinical effectiveness of minimally invasive direct coronary artery bypass grafting ( MIDCAB ) via minithoracotomy. Methods From January 2002 to January 2013, 66 patients were given MIDCAB via minithoracotomy with beating heart by using the left internal mammary artery ( LIMA) .In 59 patients, a lower partial sternotomy was carried out under single-lumen endotracheal tube anesthesia and a reverse L-form inferior segment sternotomy was performed.In 5 patients, a minimally invasive parasternal approach was emplyed under double-lumen endotracheal tube anesthesia.The patients were placed in recumbent position with left chest 30°raised.The exposure was provided by a small left anterior incision through the fourth or fifth intercostal space.A special retractor was utilized to brace the ribs.The internal mammary artery was dissected and coronary artery anastomosis was conducted.The video-assisted thoracoscopic surgery was performed in 2 patients. Results The surgery was completed in all the 66 patients by grafting the left anterior descending branch (LAD).Meanwhile, the two of them were treated additionally by grafting the diagonal artery.There was no perioperative death.Follow-up observations for 0.5-8 years (5.5 ±2.5 years) in 60 patients found disappearance of symptoms in 42 patients and alleviation of symptoms in 24 patients.Postoperatively, CT scanning was performed in 16 patients and coronary angiography, 12 patients.The satisfactory rate of anastomosis was 100%. Restenosis in the bypass was found in 1 patient, and vascular occlusion was found in 1 patient. Conclusions MIDCAB via minithoracotomy is suitable for the revascularization of anterior descending artery.The operative method has the advantages of small operation wound, rapid recovery, and good effect for a mid-and long-term therapy.It is safe and effective for those patients with a high risk of conventional procedures or with non-satisfactory interventional therapy.