CAJ | 학술논문

目的比较非体外循环冠状动脉(冠脉)旁路移植术(OPCAB)后大隐静脉序贯桥与单支桥的中期通畅率,探讨序贯吻合技术在OPCAB的应用效果. 方法选取2011年6月至2013年6月我院200例已行OPCAB的冠心病患者作为研究对象,手术采用大隐静脉序贯桥和单支桥.患者于术后(20.0±21.5)个月行冠脉血管造影(CTA),比较单支桥与序贯桥血管通畅率,并分析不同位置吻合口、不同冠脉系统以及不同冠脉的不同位置吻合口通畅率差异. 结果单支桥与序贯桥血管通畅率的比较,差异无统计学意义(x2=1.886,P=0.170);单支桥与序贯桥不同位置吻合口通畅率的比较,差异无统计学意义(x2=4.567,P=0.102);其中序贯桥远端吻合口与单支桥远端吻合口通畅率,序贯桥中间吻合口与序贯桥远端吻合口通畅率比较,差异均无统计学意义(均P＞0.05);序贯桥中间吻合口通畅率高于单支桥远端吻合口(x2 =4.653,P=0.031);各冠脉系统单支桥吻合口之间比较及序贯桥吻合口之间比较,差异无统计学意义(均P＞0.05).左前降支系统、右冠脉系统、回旋支系统分别单支桥与序贯桥吻合口通畅率比较,差异无统计学意义(均P＞0.05);各冠脉系统中间吻合口通畅率比较,差异有统计学意义(x2 =6.184,P=0.045),但远端吻合口通畅率比较,差异无统计学意义(x2=1.807,P=0.431).序贯桥与单支桥侧侧吻合及端侧吻合口通畅率比较,差异无统计学意义(均P＞0.05). 结论 OPCAB术后大隐静脉序贯桥与单支桥对中期通畅率无明显差异.其血管通畅率与吻合口方式、吻合口位置以及靶血管的质量、内径,血管桥数量等因素有关系.序贯吻合时应尽量选择条件较好的靶血管作为序贯桥的最远端血管,可以提高血管中期通畅率.
목적 비교비체외순배관상동맥(관맥)방로이식술(OPCAB)후대은정맥서관교여단지교적중기통창솔,탐토서관문합기술재OPCAB적응용효과. 방법 선취2011년6월지2013년6월아원200례이행OPCAB적관심병환자작위연구대상,수술채용대은정맥서관교화단지교.환자우술후(20.0±21.5)개월행관맥혈관조영(CTA),비교단지교여서관교혈관통창솔,병분석불동위치문합구、불동관맥계통이급불동관맥적불동위치문합구통창솔차이. 결과 단지교여서관교혈관통창솔적비교,차이무통계학의의(x2=1.886,P=0.170);단지교여서관교불동위치문합구통창솔적비교,차이무통계학의의(x2=4.567,P=0.102);기중서관교원단문합구여단지교원단문합구통창솔,서관교중간문합구여서관교원단문합구통창솔비교,차이균무통계학의의(균P＞0.05);서관교중간문합구통창솔고우단지교원단문합구(x2 =4.653,P=0.031);각관맥계통단지교문합구지간비교급서관교문합구지간비교,차이무통계학의의(균P＞0.05).좌전강지계통、우관맥계통、회선지계통분별단지교여서관교문합구통창솔비교,차이무통계학의의(균P＞0.05);각관맥계통중간문합구통창솔비교,차이유통계학의의(x2 =6.184,P=0.045),단원단문합구통창솔비교,차이무통계학의의(x2=1.807,P=0.431).서관교여단지교측측문합급단측문합구통창솔비교,차이무통계학의의(균P＞0.05). 결론 OPCAB술후대은정맥서관교여단지교대중기통창솔무명현차이.기혈관통창솔여문합구방식、문합구위치이급파혈관적질량、내경,혈관교수량등인소유관계.서관문합시응진량선택조건교호적파혈관작위서관교적최원단혈관,가이제고혈관중기통창솔.
Objective To compare the mid-term patency rates between individual and sequential saphenous vein grafts after off-pump coronary artery bypass grafting (OPCAB) and evaluate the effect of sequential anastomosis technique on the graft patency after OPCAB.Methods Clinical data of 200 patients receiving OPCAB with individual and sequential saphenous vein grafts from June 2011 to June 2013 were retrospectively analyzed.The multislice spiral CT angiography (MSCTA) was performed at an average of (20.0±21.5) months after OPCAB.The patency rate of individual and sequential grafts and anastomoses were compared,and the effect of different locations on the patency rate of the anastomoses was analyzed.Results There was no significant difference in the patency rate between individual and sequential grafts (x2 =1.886,P=0.170).The anastomosis patency rates in different locations had no significant differences between individual and sequential grafts (x2 =4.567,P=0.102).There was no significant difference in the distal anastomosis patency rate between sequential and individual grafts (P＞0.05).The anastomosis patency rate in sequential graft had no significant difference in the side-to-side anastomose versus end-to-side anastomose (P＞0.05).The patency rate of side-to-side anastomose in the sequential graft was higher than that of distal anastomose in individual graft (x2 =4.653,P=0.031).There were no significant differences in the patency rate in sequential grafts among different coronary systems (including the anterior descending branch,the right coronary artery and the circumflex branch) and individual grafts among different coronary systems respectively (all P＞ 0.05).The anastomosis patency rates had no difference between sequential and individual grafts in the anterior descending branch.There were significant difference in end-to-side anastomosis patency rates between sequential and individual grafts in different coronary systems (x2 =6.184,P=0.045),but the distal anastomosis patency rate had no difference (x2 =1.807,P=0.431).No significant difference in the patency rates between sequential and individual grafts in side-to-side versus end-to-side (all P＞ 0.05).Conclusions There is no significant difference in the mid-term patency rate between individual and sequential saphenous vein grafts after off-pump coronary artery bypass grafting (OPCAB).The patency rate is related with the anastomotic mode,the location of anastomotic,and the quality of the target vessel,diameter,number of grafts and other factors.The mid-term patency rate can be improved by choosing the target vessel with better conditions as the most distal sequential bridge,when conducting sequential anastomosis technique.