CAJ | 학술논문

目的比较使用非体外循环心脏不停跳冠状动脉旁路移植术(OPCAB)、微创小切口直视下心脏不停跳冠状动脉旁路移植术(MIDCAB)和机器人辅助冠状动脉旁路移植术(RA-CAB)3种不同方式行左前降支(LAD)血运重建的围手术期效果.方法 2009年2月至2012年5月,接受单纯LAD血运重建患者102例,其中OPCAB组31例,MIDCAB组45例,RA-CAB组26例.MIDCAB手术方式为左胸小切口心脏不停跳冠状动脉旁路移植术,RA-CAB手术方式为da Vinci机器人辅助左乳内动脉(LI-MA)获取,左胸小切口心脏不停跳冠状动脉旁路移植术.结果 3组患者在术中旁路血管流量、搏动指数和围手术期死亡、心肌梗死、脑血管意外、再次血运重建、严重心脑血管不良事件(MACCE事件)、肾功能衰竭、再次开胸止血、新发心房颤动、纵隔感染以及术后并发症率上均无显著差异.相比OPCAB,MIDCAB和RA-CAB能显著减少输血率(4.4％对32.3％,P＜0.05；7.7％对32.3％,P＜0.05),其中RA-CAB更能显著缩短术后住院天数[(8.8±3.2)天对(12.4±7.7)天,P＜0.05)].MIDCAB与RACAB两组之间围手术期结果差异无统计学意义.结论 MIDCAB和RA-CAB治疗左前降支血管病变安全、有效、可行,围手术期效果满意,比OPCAB能显著减少血制品的使用,RA-CAB更能大大缩短术后住院天数,具有创伤更小、恢复更快的优势.
목적 비교사용비체외순배심장불정도관상동맥방로이식술(OPCAB)、미창소절구직시하심장불정도관상동맥방로이식술(MIDCAB)화궤기인보조관상동맥방로이식술(RA-CAB)3충불동방식행좌전강지(LAD)혈운중건적위수술기효과.방법 2009년2월지2012년5월,접수단순LAD혈운중건환자102례,기중OPCAB조31례,MIDCAB조45례,RA-CAB조26례.MIDCAB수술방식위좌흉소절구심장불정도관상동맥방로이식술,RA-CAB수술방식위da Vinci궤기인보조좌유내동맥(LI-MA)획취,좌흉소절구심장불정도관상동맥방로이식술.결과 3조환자재술중방로혈관류량、박동지수화위수술기사망、심기경사、뇌혈관의외、재차혈운중건、엄중심뇌혈관불량사건(MACCE사건)、신공능쇠갈、재차개흉지혈、신발심방전동、종격감염이급술후병발증솔상균무현저차이.상비OPCAB,MIDCAB화RA-CAB능현저감소수혈솔(4.4％대32.3％,P＜0.05；7.7％대32.3％,P＜0.05),기중RA-CAB경능현저축단술후주원천수[(8.8±3.2)천대(12.4±7.7)천,P＜0.05)].MIDCAB여RACAB량조지간위수술기결과차이무통계학의의.결론 MIDCAB화RA-CAB치료좌전강지혈관병변안전、유효、가행,위수술기효과만의,비OPCAB능현저감소혈제품적사용,RA-CAB경능대대축단술후주원천수,구유창상경소、회복경쾌적우세.
Objective Off-pump coronary artery bypass (OPCAB),minimally invasive direct coronary artery bypass (MIDCAB) and robotic-assisted coronary artery bypass (RA-CAB) are all used to treat isolated left anterior descending artery (LAD) disease.The aim of this study is to compare the early outcomes after these three procedures.Methods From February 2009 to May 2012,102 consecutive patients underwent revascularization of LAD.31 patients were treated by OPCAB,45 by MIDCAB and 26 by RA-CAB.Patients received sternotomy in the OPCAB procedures.The MIDCAB procedures were performed through a 10-cm anterolateral muscle-sparing minithoracotomy.In the RA-CAB procedures,left internal mammary arteries (LIMA) were harvested with the aid of da Vinci surgical system and sewing of the anastomoses was performed under direct vision by a 3-cm anterolateral minithoracotomy.Results No significant difference was observed in graft flow,pulse index,renal failure,reoperation for hleeding,new onset of arterial fibrillation and deep wound infection between these three groups.There was also no significant difference in peri-operative mortality,major adverse cerebro-cardiovascular events (MACCE) between these three groups.Compared with OPCAB,MIDCAB and RA-CAB significantly reduced the need of blood transfusion (4.4％ vs.32.3％,P＜ 0.05; 7.7％ vs.32.3％,P＜0.05).The patients receiving RA-CAB had shorter length of postoperative stay than whom receiving OPCAB[(8.8 ± 3.2) days vs.(12.4 ± 7.7) days,P ＜ 0.05)].There is no significant difference between the outcomes of MIDCAB and RA-CAB.Conclusion These findings indicated that MIDCAB and RA-CABwere feasible,effective and safe options for revascularization of isolated LAD disease.MIDCAB and RA-CAB showed the advantage of less invasive and faster recovery,compared with OPCAB.Therefore,MIDCAB and RA-CAB should be the routine treatment for patients with isolated LAD disease.In some advanced centers,RA-CAB will be the preferred method.The mid-and long-term outcomes of these three methods should be further investigated.