【摘要】 自１９９６年１２月至１９９８年３月，为３２例冠心病病人施行以乳内动脉（ＩＭＡ）、胃网膜右动脉（ＧＥＡ）及桡动脉（ＲＡ）为血管材料的全动脉化冠状动脉（ＣＡ）搭桥术，同时施行贲门癌切除、胃食管吻合术１例，心梗后室间隔穿孔修补术１例，心梗后室壁瘤切除术６例。全组７例取用ＧＥＡ，２９例取用ＲＡ（１０例双侧），每例均取用左侧ＩＭＡ（１５例双侧），以人均２．９个动脉桥完成人均３．５个远端吻合（最多者６个）。７例采用了３种动脉桥，２５例采用ＩＭＡ和ＲＡ２种动脉桥。１７例用ＲＡ做“蛇”形桥。１例用右ＩＭＡ做第１室间隔支搭桥。创用“Ｖ”字形ＲＡ自体血管壁加宽近端吻合口的方法，成功地完成了较细ＲＡ与主动脉间的近端吻合。全组未发现与取材有关的并发症。术后心电图、超声心动图和核素心肌显像提示，搭桥区域的心肌灌注和心室功能均较术前明显改善。初步实践证明，全动脉化ＣＡ搭桥术虽然难度较大，但术后效果好，并可望比传统的静脉桥有更理想的远期通畅率更多还原

【Abstract】 Aim:It is proven that the long term patency rate of arterial graft after coronary bypass operation is much higher than vein graft.In this clinical work internal mammary artery(IMA),radial artery(RA)and gastroepepolic artery(GEA)were used as complete arterial grafts for coronary revascularization.Clinical material and method:Between Decembar 1996 and March 1998,32 cases(30 male and 2 female),with mean age of 56.5 years(38.74),underwent coronary bypass operation with complete arterial grafts mentioned above.3.5 distal anastomoses with 2.9 arterial conduits for each case were performed.GEA was harvested in 7 cases,RA in 29 cases,and bilateral RA in 10.IMA was taken for each case and bilateral IMAs were used in 15 cases.All the three arterial grafts were used in 7 cases.IMA and RA were used in 25 cases.In 17 cases,sequential distal anastomoses were performed by using RA grafts.The anastomosis of IMA to first septal branch was performed in one case and figure“Y”anastomosis was done by using natural distal bifurcation of RA in one case.The combined procedures included cardiectomy and gastroesophagostomy for a patient with cardiac cancer,repair of postinfarction VSD for one patient and resection of postinfarction ventricular aneurysm for 6 patients.When the RA is too thin,the caliber of its proximal end was doubled by inserting its“V”shaped arterial wall so as to have the proximal anastomosis easier.Results:There were no harvestrelated complications.The clinical symptoms were relieved.After surgery,postoperative ECG,echocardiography and 99mTc scanning have shown that myocardial perfusion and cardiac function have improved.Conclusion:This technique is more difficult than using vein graft.But the postoperative result is satisfying and the long term patency rate will reasonably be longer than vein graft.This technique is hopefully a promising one in coronary surgery.更多还原