Objective To investigate the clinical application of the right grstroepiploic artery (RGEA) in offpump coronary artery bypass grafting (OPCAB). Methods We retrospectively analyzed the clinical data of the 38 patients who underwent RGEA grafts for OPCAB between December 2008 and July 2009 in the First Affiliated Hospital of Nanjing Medical University. According to the difference of grafts, 76 patients undergoing OPCAB were divided into two groups. In the RGEA group, there were 38 patients including 36 males and 2 females with an age of 65.87±6.29 years. For the patients in this group, OPCAB was carried out with RGEA and other routine conduits as grafts. The control group had 38 patients including 35 males and 3 females with an age of 66.68±6.24 years. They underwent OPCAB with left internal mammary artery (LIMA), radial artery (RA), or saphenous vein (SV) as grafts. The intraoperative and postoperative clinical data for patients in both groups were analyzed and compared. Results All operations were carried out without serious complications like reoperation for bleeding, functional delayed gastric emptying, or severe infection, and no operative death occurred. Compared with the control group, operative time in the RGEA group was longer (295.53±45.16 min vs. 262.50±42.44 min,P=0.001), the number of anastomotic stomas [CM(159mm]was less (4.71±0.56 vs. 5.29±0.92, P=0.002), and less intraoperative plasma was consumed (194.74±186.30 ml vs. 565.79±382.70 ml, P=0.000). The 24 h drainage loss (394.71±205.36 ml vs. 536.32±258.85 ml, P=0.008), the blood cell consumption (1.67±1.48 U vs. 2.81±2.48 U, P=0.010) and the postoperative hospital stay (12.47±3.20 d vs. 15.47±9.31 d, P=0.035) were significantly lower in the RGEA group compared with those in the control group. Meanwhile, the time of postoperative mechanical ventilation time was longer in the RGEA group than that in the control group (1 398.82±1 349.94 min vs. 985.39±170.30 min, P=0.036). Seventytwo patients were followed up for a period from 9 to 17 months with 4 cases lost. No myocardial ischemia occurred in both groups of patients. Conclusion RGEA is an effective arterial conduit for OPCAB. It needs high technology and takes long operative time to apply RGEA in OPCAB.
目的總結腔內封堵技術治療食管癌術后吻合口瘺的應用經驗。 方法回顧性分析2006年8月至2011年12月上海中醫藥大學附屬曙光醫院應用腔內封堵技術治療食管癌術后吻合口瘺15例患者的臨床資料，其中男12例、女3例，年齡47～73歲。分析其臨床效果。 結果竇道造影證實于瘺口附近有竇道形成者，瘺口直徑＜0.5 cm者10例一次堵漏成功；瘺口直徑大于0.5 cm者1例，堵漏二次后成功。瘺口附近竇道形成不明顯者4例，堵漏均失敗。 結論腔內封堵技術治療食管癌術后吻合口瘺有相當的臨床效果。瘺口附近有竇道形成是堵瘺成功的關鍵。