翻转胸廓内动脉冠状动脉旁路术的实验研究

目的 研究翻转胸廓内动脉用于冠状动脉旁路术的可行性。方法 对１０具成人尸体胸廓内动脉的特性进行观察,并测量左、右各助间点到ＩＴＡ起点、冠状动脉左前降支中点的距离。结果 于近端切断胸廓内动脉可以保证该动脉逆向供血,血供来源于下位肋间动脉、肌隔动脉和腹壁上动脉。左侧第３肋间以下的各肋间中点,到ＩＴＡ起点处的长度明显长于其到冠状动脉左前降支中点的距离;右侧第４肋间以下的各肋间中点,到ＩＴＡ起点处的长距离     

胃网膜右动脉与胸廓内动脉在冠状动脉旁路术中应用的比较研究

目的：为将胃网膜右动脉应用于冠状动脉旁路术提供依据。方法：观测了３８具成人尸体的胃网膜后动脉和胸廓内动脉，并对其中３０例进行了组织学观察及体视学计量。     

胸廓内动脉的解剖及超声研究进展

胸廓内动脉（Internal Thoracic Artery，ITA）又称乳房内动脉，因其解剖位置恒定、生物学特征良好及移植后具有长期通畅性等特点，作为移植血管越来越受到人们的重视，是行冠状动脉搭桥术、肝脏肿瘤介入治疗、乳房再造术和吻合血管的游离组织移植修复胸壁缺损的首选受区吻合血管。     

甲状腺下动脉发自胸廓内动脉一例

笔在解剖一具成年男性尸体时发现其右侧甲状腺下动脉变异,现报道如下：     

左胸廓内动脉合并左肺分叶变异一例

女尸1具,40岁左右,身高约155cm。发育欠佳,死因不明。解剖过程中发现：左胸廓内动脉起源于左侧腋动脉,从距左腋动脉根部约6．3cm处发出,穿行于尺神经与正中神经之间抵达腋窝底,在窝底内穿出腋筛筋膜迂曲向前上行至腋前襞,横行向胸内侧走行于左乳房上缘的浅筋膜内（双侧乳房发育不良）,抵至胸骨角第2肋间隙处进入胸腔,在胸腔内行于胸骨左缘1．1cm处。此动脉从起始处至入胸腔处全长34．4cm,管径约0．45cm,迂曲呈正弦波形态。其中从起始处至左腋前襞约10．6cm,腋前襞至入胸腔处13．8cm。     

冠状动脉旁路术中动脉供体的研究进展

临床冠状动脉旁路术(ｃｏｒｏｎａｒｙａｒｔｅｒｙｂｙｐａｓｓ,ＣＡＢ)始于1962年,当时使用的血管供体为大隐静脉(ｓａｐｈｅｎｏｕｓｖｅｉｎ,ＳＶ)[1]。到1968年,胸廓内动脉(ｉｎｔｅｒｎａｌｔｈｏｒａｃｉｃａｒｔｅｒｙ,ＩＴＡ)开始用于ＣＡＢ,并很快得到推广[2,3]。在随访过程中,不少作者发现,术后ＩＴＡ的通畅率明显高于ＳＶ,并认为其根本原因在于:ＩＴＡ具有与冠状动脉相似的结构和生理特性,而ＳＶ却不具备这些动脉特性,这为动脉供体的应用提供了依据[3,4]。此后,不少自体动脉被用于ＣＡＢ,使ＣＡＢ有了更多的动脉供体来源。对于…     

胃网膜动脉与冠状动脉搭桥术的应用解剖

为胃网膜动脉与冠状动脉搭桥术提供解剖学资料。本文在30具成年尸体上对胃网膜动脉、网膜动脉和冠状动脉进行了观测。测量结果:胃网膜动脉弓长度为29.3cm;而胃网膜右动脉的起始部至主动脉根部为28.9cm;胃网膜左动脉起始部至主动脉根部为29.2cm。测量数据表明,应用胃网膜动脉移位术足以吻接任何冠状动脉。     

桡动脉在冠状动脉旁路术中的应用解剖学研究

目的：为应用桡动脉作冠状动脉旁路术(coronary artery bypass grafting，CABG)的动脉桥提供解剖学依据。方法：观测了35具成人尸体的两侧桡动脉长度、外径、毗邻结构和可用于CABG的长度和外径。结果：桡动脉总长度为20．87cm，可用于CABG的长度为19．99cm；桡动脉上端外径为3．18mm，可用于CABG的桡动脉上端、中点、下端外径分别是2．66mm、2．28mm、2．29mm。结论：桡动脉有足够的长度和与冠状动脉相匹配的外径，可作为CABG的动脉桥。     

肋间动脉与冠状动脉搭桥的应用解剖

为肋间动脉与冠状动脉搭桥术提供解剖学资料,在40侧成年尸体上对第七、八对肋间动脉进行了观察.左侧第七肋间动脉至液后线长平均为19.5cm.至锁骨中线为26cm;左侧第八肋间动脉长分别为19.7cm和27.5cm;右侧第七肋间动脉长分别为20.7cm和27.5cm;右侧第八肋间动脉长分别为21.2cm和28cm.     

胃网膜左动脉与冠状动脉搭桥术的应用解剖

在15例成尸标本上对胃网膜右动脉进行了观测.动脉长度为22.8cm.其末端位于胃大弯中点偏左,此处可见一束胃壁支。在胃网膜右动脉起始部稍下方、中点及其末端测得外径分别为2.1mm、1.6mm 和1.2mm.胃壁支在上述三点的长度分别为18.8mm、13.7mm 和12.0mm.胃膜右动脉自起始部至心膈面冠状沟的长度平均19.8cm。     

Serum adiponectin and markers of endothelial dysfunction in stable angina pectoris patients undergoing coronary artery bypass grafting (CABG)

PurposeIt has been established that endothelial dysfunction (ED) occurs after coronary artery bypass grafting (CABG). The aim of the study was to assess whether adiponectin may act as a novel marker of ED and its potential relations with new markers of ED: novel cell adhesion molecule CD146, a natural anti-thrombin glycoprotein – thrombomodulin (TM) and the well-established ED marker – Von Willebrand factor (VWF) in coronary artery disease (CAD) patients undergoing CABG.Material/methods45 CAD patients undergoing elective CABG were included in the study.ResultsIn the study group the concentration of adiponectin and CD146 before the surgery were significantly lower than in the control group – 6.06 μg/ml ± 3.06 vs. 19.0 μg/ml ± 6.4 and 303.2 ng/ml ± 28.7 vs. 328.1 ng/ml ± 22.6 (p < 0.05). Significant increase of adiponectin and CD146 concentration 3 months after CABG vs. before the surgery was found. Adiponectin concentration 3 months after CABG correlated with VWF, TM, CD146, and a number of grafts. CD146 before and 3 months after CABG correlated significantly with adiponectin, VWF activity as well as the statins therapy after the surgery.ConclusionsIn CAD patients undergoing CABG new markers of endothelial cell dysfunction as adiponectin and CD146 are significantly lower compared to healthy volunteers. Significant increase in adiponectin and CD146 concentration 3 months after CABG vs. before the surgery was found. However adiponectin concentrations 3 months after CABG were still significantly lower compared to healthy individuals, whereas CD146 concentration returned to the values comparable to the control.     

冠状动脉旁路移植治疗冠状动脉肌桥9例分析

目的回顾冠状动脉旁路移植术治疗症状性肌桥的外科治疗经验及结果。方法选取2004年3月至2011年1月因冠状动脉肌桥导致冠状幼脉血流堵塞需行冠状动脉旁路移植术的患者资料9例,采用胸廊内动脉到前降支进行旁路移植,2例取大隐静脉与其他病变冠状动脉进行旁路移植。结果全组无患者死亡,无术中相关并发症发生。所有患者随访4个月至7年,临床症状均明显改善,无心绞痛发生,无心肌梗死及其他主要心血管不良事件（再血管化或死亡等）发生。结论冠状动脉旁路移植治疗有症状的肌桥安全、有效。     

Comparing mortality and myocardial infarction between coronary artery bypass grafting and drug-eluting stenting in patients with diabetes mellitus and multivessel coronary artery disease: a meta-analysis

Introduction

We aim to compare the midterm outcomes between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in diabetic patients who had multivessel coronary artery diseases (CAD).

Material and methods

A comprehensive literature search was conducted to identify the related clinical studies with a follow-up for 1 year at least. The endpoints were death, myocardial infarction, and major adverse cardiac and cerebrovascular events (MACCE).

Results

Finally, the analysis of ten studies involving 5,264 patients showed that patients with CABG had worse baseline characteristics, a higher rate of stable angina pectoris, a higher percentage of triple-vessel disease, higher incidence of chronic total occlusion and a higher SYNTAX score. However, there was no significant difference in mortality between the two groups. Additionally, the rates of myocardial infarction and MACCE were markedly decreased in the CABG group.

Conclusions

The strategy of CABG is better than PCI for diabetic patients with multivessel CAD. The CABG can significantly reduce the rates of myocardial infarction and MACCE and is comparable in mortality despite the worse baseline characteristics.     

桡动脉在全动脉化冠脉搭桥术中的临床应用

目的探讨桡动脉在全动脉化冠脉搭桥术中的临床应用效果。方法22例患者采用乳内动脉和桡动脉行全动脉化冠脉搭桥手术,"不接触血管技术"游离桡动脉,与冠状动脉对角支、钝缘支、前降支、右冠状动脉等单独或序贯吻合,共搭桥31支。术后应用钙通道阻滞剂防止桡动脉痉挛。结果22例手术均顺利完成,痊愈出院,无围术期心肌梗塞,术后心肌缺血改善,无手部缺血并发症。随访2月～3年,无心绞痛复发,手部功能正常。结论桡动脉作为血管桥材料在全动脉化冠脉搭桥术中应用效果良好。     

Coronary artery bypass grafting with concomitant resection for carcinoma of lung

A 69-year-old woman with angina had a lesion in the left lower lobe on chest film. Angiography revealed coronary artery disease in three vessels. Combined off pump coronary artery bypass grafting (CABG) and left lower lobectomy were performed through median sternotomy. This approach avoids complications due to staged operations and cardiopulmonary bypass (CPB). This report shows that simultaneous off pump CABG and pulmonary operations can be performed safely in patients with coronary artery disease (CAD) associated with lung cancer.