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冠状动脉旁路移植术中旋股外动脉降支的获取与运用

Application of the descending branch of the lateral circumflex femoral artery in the coronary artery bypass grafting operation

摘要:

目的 探讨在冠状动脉旁路移植术中,获取旋股外动脉降支作为旁路血管材料的技术操作方法与旁路建立策略.方法 2016年12月至2017年4月对中国医学科学院阜外医院心血管外科19例拟采用旋股外动脉降支进行冠状动脉旁路移植术的患者行下肢动脉CT血管造影筛查.对16例合适取用者[男性14例,女性2例,平均年龄(47.4±8.5)岁],利用大腿前侧切口游离获取左侧(13例)或右侧(3例)旋股外动脉降支16支,并配合双侧胸廓内动脉(12例)、非利侧桡动脉(7例)和大隐静脉(3例),在心肺转流辅助下(10例)或心脏不停跳下(6例)完成冠状动脉旁路移植术.结果 3例患者因术前CT筛查发现股动脉粥样硬化病变狭窄(1例)和降支血管走行变异、短小(2例)而放弃取用,其余16例均成功获取旋股外动脉降支用作旁路血管.每例患者术中平均建立(3.4±0.6)支旁路,无手术死亡.获取的旋股外动脉降支平均长度为(10.3±1.8)cm,平均内径为(1.9±0.5)mm.其中15支旋股外动脉降支作为游离桥建立前降支(1支)、对角支(7支)、中间支(6支)和回旋支第二钝缘支(1支)旁路血管.1例与左胸廓内动脉构建"Y"形复合动脉旁路后再建立回旋支第三钝缘支旁路血管.结论 旋股外动脉降支是临床可行的冠状动脉旁路移植术中动脉旁路血管,获取简便,使用安全.因其走行和长度都有变异,术前应对下肢动脉进行CT血管造影筛查,术中应采取合适的旁路建立策略.

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abstracts:

Objective To investigate the technical method for harvesting and application of the descending branch of the lateral circumflex femoral artery ( DBLCFA) in the coronary artery bypass grafting ( CABG) operation. Methods Between December 2016 and April 2017, 19 patients were arranged to use DBLCFA and got CT angiography ( CTA) of pelvic and femoral arteries pre-operative at Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Finally, DBLCFA was harvested in 16 patients (including 2 female patients, with a mean age of (47. 4±8. 5) years) through the anterior thigh incision (13 cases on the left side, 3 cases on the right side). The CABG operations were performed under the cardiopulmonary bypass support ( in 10 cases) or under the beating heart condition ( in 6 cases) , and the DBLCFA conduit was used combining with bilateral internal thoracic artery ( in 12 cases ) , radial artery ( in 7 cases) and saphenpous vein ( in 3 cases) . Results Due to anatomical variations such as short length and anomalous branch, or due to silent atherosclerosis stenosis of femoral artery, DBLCFA in 3 patients was considered inappropriate for use and was not harvested after CTA examination. In another 16 patients, DBLCFA was safely and quickly harvested and successfully used. On average, 3. 4 ± 0. 6 anastomosis was built up in CBAG, no adverse effects were exhibited. The length of the harvested DBLCFA was (10. 3±1. 8) cm, with average lumen diameter of (1. 9±0. 5) mm. DBLCFA was used as free graft in 15 patients ( 7 to the first diagonal branch, 6 to the ramus intermedius branch, 1 to the left anterior descending branch and 1 to the second obtuse marginal branch ) . In 1 patient, the DBLCFA was firstly implanted end-to-side to the internal thoracic artery as a"Y" type composite graft, and then anastomosed to the third obtuse marginal branch. Conclusions The descending branch of the lateral circumflex femoral artery is an option conduit in CABG. It can be harvested easily and safely. However, pre-operative CTA examination is necessary to exclude the variation and appropriate strategy for graft establishment should be considered during the operation.

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作者: 罗新锦 [1] 王巍 [1] 王跃堂 [1] 杨阳 [1] 李涵 [1] 王旭 [1] 胡盛寿 [1]
第一作者: 罗新锦
作者单位: 100037,国家心血管病中心 中国医学科学院 北京协和医学院 阜外医院心血管外科 [1]
期刊: 《中华外科杂志》2017年55卷11期 834-837页 MEDLINEISTICPKUCSCD
栏目名称: 临床新技术
DOI: 10.3760/cma.j.issn.0529-5815.2017.11.003
发布时间: 2017-12-06
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