Coronary Artery Surgery-Recent Developments

冠狀動脈手術－近來發展

邱冠明(Kuan-Ming Chiu) ； 朱樹勳(Shu-Hsun Chu)

《Acta Cardiologica Sinica》 21卷3期 (2005/09) Pp. 131-136

摘要

心臟外科的手術在1953年Dr. Gibbon發明心肺機之後就有長足的進步，在1960年代末期，繞道手術的成功奠定了外科在冠心症的治療的重要地位。直到1980年代，冠狀動脈氣球擴張術和支架置放術的發明，重新改寫了冠心症治療的流程。隨著新科技的演進，冠狀動脈的手術也有新的進展。微創手術是所有外科的共同趨勢，繞道手術自然不能例外，除了縮小傷口，避免胸骨的切閉以外，最重要的是去除體外循環的可能危害，因此在新科技的協助之下，不停跳的繞道手術逐漸普及，雖然使用心肺機與否的優缺點仍有爭議，但越來越多支持的証據和手術個案卻是事實。此外，內視鏡的引進和機械手臂都是微創的延伸，而內視鏡血管摘取術也成為減少術後併發症和改善滿意度的重要環節。實証醫學的資料顯示，繞道手術中動脈移植較靜脈移植佳，許多新藥物的使用也可延長長期的暢通率，更加改善冠心症的外科治療成績。從病患的觀點出發，在術中確認血管吻合的成效，以fast track使患者提早恢復，盡一切可能減少繞道手術後出現腦血管意外的風險，都是近年來重要的品質指標。在面臨更多挑戰的未來，心臟外科醫師有責任以最低的風險，提供更好的治療成績，以符合患者的期望。

關鍵字

冠狀動脈繞道 ； 不停跳 ； 內視鏡血管摘取 ； 微創手術

並列摘要

Cardiovascular surgery had great advancement in the twentieth century. In 1929, Werner Forssman performed the first human cardiac catheterization on himself. Then cardiac catheterization gradually became a gold standard in the diagnosis of congenital heart diseases as well as valvular heart diseases. In 1953, Gibbon set a milestone for cardiac surgery by invention of cardiopulmonary bypass. Mason Sones performed the first diagnostic coronary angiogram at Cleveland Clinic in 1958. Rene Favaloro did the first coronary artery bypass grafting (CABG) in 1967. From then on, coronary artery diseases (CAD) have had excellent resolution. 1977 saw Andreas Gruentzig change the landscape by doing the first coronary angioplasty on an awake human. Julio Palmaz and Richard Schatz pushed the advance further by invention of balloon expandable stents to address the issues of recoil and restenosis after balloon angioplasty. Cardiologists have modernized myocardial revascularization by much investment and great innovation. Percutaneous coronary intervention started to play a major role in the myocardial revascularization in the last two decades. The advent of new technologies provides many less invasive methods of myocardial revascularization, such as percutaneous transluminal coronary angioplasty (PTCA), stents, brachytherapy, intravascular ultrasound, rotablator, and drug-eluting stents.

並列關鍵字

Coronary artery bypass ； Off-pump ； Endoscopic vessel harvest ； Minimally invasive surgery