Endoscope-Assisted Minimally Invasive Surgery for Coronary Artery Bypass

內視鏡輔助微創冠狀動脈繞道手術

邱冠明(Kuan-Ming Chiu) ； 林子玉(Tzu-Yu Lin) ； 李紹榕(Shao-Jung Li) ； 陳哲伸(Jer-Shen Chen) ； 詹志洋(Chih-Yang Chan) ； 朱樹勳(Shu-Hsun Chu)

《Formosan Journal of Surgery》 40卷3期 (2007/06) Pp. 111-116

https://doi.org/10.29833/FJS.200706.0002

摘要

近年來心臟外科醫師開始將內視鏡應用於冠狀動脈繞道手術，但如何利用內視鏡摘取左側內乳動脈，在技術上仍具有相當大的挑戰。
自2002年4月至2004年4月，我們爲40位病人以左側內乳動脈進行左前降枝繞道手術，其中1人以內視鏡摘取左側內乳動脈。
所有病人在手術後均恢復良好，以內視鏡摘取左側內乳動脈所耗費時間爲38至125分鐘（平均6分），這些摘取後的左側內乳動脈均能保持通暢。手術開胸長度為5至8公分（平均6.2公分），其中10位病人在術後立即拔除氣管內管，1位病人則因胸腔積血而插入胸管。所有病人在術後接受加護照顧時間為0至40小時（平均7小時），停留在加護病房時間為1.3±0.3天，而住院時間則為6.2±1.5天。
由我們的經驗顯示，以內視鏡摘取左側內乳動脈是可行的，此法有助於減少傷口長度及術後恢復時問，且拉長移植長度幫助吻合，提供給病人一個侵入性較低的良好替代方案。

並列摘要

Objective: Cardiac surgeons began in this decade to apply the endoscopes in their practices. Endoscopic graft harvest for coronary artery bypass surgery (CABG) has become the routine practice in many institutes. However, endoscopic harvest of the left internal mammary artery (LIMA) has remained a technical challenge.
Methods: From April 2002 to April 2004, 40 patients underwent minimally invasive direct CABG using LIMA to left anterior descending (LAD) artery bypass. Twentyone of them had endoscopic harvest of LIMA.
Results: There was neither early nor late operative mortality. Endoscopic LIMA harvest time ranged from 38 to 125 minutes (mean 56 minutes). All harvested LIMAs had a burst flow while being cut from the distal end. The length of
thoracotomy was 5 to 8 cm (mean 6.2 cm).Ten patients were extubated immediately. One patient had hemothorax which required chest tube insertion. The intensive care unit (ICU) ventilation time was 0 to 40 hours (mean 7 hours). The ICU stay and hospital stay were 1.3±0.3 and 6.2±1.5 days, respectively.
Conclusions: Endoscope-assisted LIMA harvest is a feasible technique. The learning curve, however, shows that this approach reduces wound length, recovery time, and helps extend the graft length to facilitate the anastomosis. It provides patients with an alternative choice to have a satisfactory conduit in a minimally invasive way.

並列關鍵字

minimally invasive direct coronary artery bypass ； endoscopic harvest ； internal mammary artery