Thoracoscopic internal mammary artery harvesting approach in MIDCAB

中华胸心血管外科杂志 Pub Date : 2013-05-25 DOI:10.3760/CMA.J.ISSN.1001-4497.2013.05.012

Xing-hai Hao, F. Wan, Hong Zhao, Z. Cui, Qiang Liu, Zhiming Song

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引用次数: 0

Abstract

Objective To analysis of preoperative preparation,operation,character,advantage and deficiency of two non-robotic TIMAH approach in MIDCAB,and to observe the short-term follow up result.Methods 7 male CAD patients with classic unstable angina pectoris,the age ranged from 52 to 75 years,average (63.8 ± 8.5) years,underwent TIMAH and MIDCAB,in which 6 single LAD disease patients and one patient for reoperation with saphenous vein graft (SVG) graft failure to LAD and progressive obtuse marginal(OM) coronary artery disease.These patients were intubated with a double-lumen endotracheal tube,and one-lung ventilation were used to facilitate the procedure.In the approach of two incisions TIMAH for 4 patients,the thoracoscope was placed at the third intercostals space(ICS) on the anterior axillary line,and LIMA was dissected with endo-instruments placed from the two angles of mini-thoracotomy at fifth ICS on the midclavicular line.In the approach of three incisions TIMAH for 3 patients,LIMA was dissected with endo-instruments placed from two ports at the fourth ICS on the anterior axillary line and at the fifth ICS on the midclavicular line,and the thoracoscope was placed at the second or third intercostals space (ICS) on the anterior axillary line.Anastomosis of LIMA and LAD followed through mini-thoracotomy at fifth ICS with the heart stabilizer after TIMAH.SVG graft was used from LIMA to OM in the reoperation patient.Results All patients underwent TIMAH and MIDCAB safely without transferece to stenotomy,only one LIMA was extended with 2 cm SVG for injure at the distal.In 6 single vessel disease patients the length of mini-thoracotomy incision was (6.0 ± 0.9) cm,TIMAH time was (112 ±18) min,operation time was (293 ± 75) min,bleeding volume was (233 ± 52) ml,endotracheal tube time was (14.2 ± 10.7) h,ICU time was (1.8 ±0.4) d and hospital stay time was (10.1 ±6.7) d.All patients were uneventful discharged and with no recurrence of cardiac symptoms in short-term follow up.Conclusion TIMAH can perform safely in both approaches for LIMA prepare to MIDCAB as described before.The minimally invasive procedure need not enlarge incision for LIMA harvesting with good short term results. Key words: Thoracoscopes ; Coronary artery bypass, off-pump ; Surgical procedures, minimally

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胸腔镜下乳腺内动脉切除术治疗MIDCAB

目的分析两种非机器人TIMAH入路在MIDCAB中的术前准备、操作、特点、优缺点，并观察近期随访结果。方法7例男性CAD合并典型不稳定型心绞痛患者，年龄52 ~ 75岁，平均(63.8±8.5)岁，行TIMAH和MIDCAB，其中6例LAD单发病变，1例再手术并发LAD隐静脉(SVG)移植失败及进行性钝缘(OM)冠状动脉病变。这些患者插管双腔气管内管，并使用单肺通气以促进手术。在TIMAH两切口入路中，4例患者将胸腔镜置于腋窝前线上的第三肋间隙(ICS)，在锁骨中线上的第五肋间隙的两个小开胸角度放置内置器械解剖LIMA。在TIMAH三切口入路中，3例患者在腋前线上的第4个ICS和锁骨中线上的第5个ICS的两个端口放置了内器械，并在腋前线上的第2或第3个肋间隙(ICS)放置了胸腔镜。再手术患者行LIMA与LAD吻合，在第5 ICS行小开胸并加心脏稳定剂，从LIMA到OM采用svg移植物。结果所有患者均安全进行了TIMAH和MIDCAB手术，未转移到开窄术，只有1例LIMA在远端损伤时用2cm SVG延长。6例单血管疾病患者小开胸切口长度为(6.0±0.9)cm,TIMAH时间为(112±18)min，手术时间为(293±75)min，出血量为(233±52)ml，气管插管时间为(14.2±10.7)h,ICU时间为(1.8±0.4)d，住院时间为(10.1±6.7)d，所有患者均顺利出院，短期随访无心脏症状复发。结论如前所述，TIMAH在LIMA预备MIDCAB的两种入路中都是安全的。微创手术无需扩大切口，短期效果良好。关键词:胸腔镜;冠状动脉旁路手术;最低限度的外科手术

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来源期刊

中华胸心血管外科杂志

CiteScore

0.20

自引率

0.00%

发文量

6779

期刊介绍： The Chinese Journal of Thoracic and Cardiovascular Surgery is an academic journal sponsored by the Chinese Medical Association. It mainly publishes original research papers, reviews and comments in this field. The journal was founded in 1985 and is included in well-known databases such as the CSCD Chinese Science Citation Database Source Journals (including extended versions) and the Statistical Source Journals (China Excellent Science and Technology Papers Journals). It is one of the national key academic journals under the supervision of the China Association for Science and Technology. The Chinese Journal of Thoracic and Cardiovascular Surgery enjoys a high reputation and influence in the academic community. The articles published in the journal have a high academic level and practical value, providing readers with a large number of practical cases and industry information, and have received widespread attention and citations from readers.