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.
目的总结腔内封堵技术治疗食管癌术后吻合口瘘的应用经验。 方法回顾性分析2006年8月至2011年12月上海中医药大学附属曙光医院应用腔内封堵技术治疗食管癌术后吻合口瘘15例患者的临床资料，其中男12例、女3例，年龄47～73岁。分析其临床效果。 结果窦道造影证实于瘘口附近有窦道形成者，瘘口直径＜0.5 cm者10例一次堵漏成功；瘘口直径大于0.5 cm者1例，堵漏二次后成功。瘘口附近窦道形成不明显者4例，堵漏均失败。 结论腔内封堵技术治疗食管癌术后吻合口瘘有相当的临床效果。瘘口附近有窦道形成是堵瘘成功的关键。