Kashiyama Noriyuki, Toda Koichi, Miyagawa Shigeru, Nishi Hiroyuki, Yoshikawa Yasushi, Fukushima Satsuki, Yoshioka Daisuke, Masashi Kawamura, Saito Tetsuya, Sawa Yoshiki
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, Osaka, 565-0087, Japan.
Surg Today. 2015 Sep;45(9):1190-3. doi: 10.1007/s00595-014-1057-3. Epub 2014 Oct 29.
We performed successful off-pump coronary artery bypass grafting (OPCAB) in a patient with unstable angina caused by triple-vessel disease, who had undergone esophagectomy with substernal gastric tube reconstruction for esophageal cancer 40 years earlier. Preoperative multidetector-row computed tomography was done to evaluate the course of the gastric tube and also that of the gastroepiploic artery, which feeds the gastric tube. Following careful sternal re-entry and adequate dissection, OPCAB was performed safely via a median sternotomy without injuring the gastric tube or causing hemodynamic instability. The patient had an uneventful early postoperative course.
我们为一名因三支血管病变导致不稳定型心绞痛的患者成功实施了非体外循环冠状动脉搭桥术（OPCAB），该患者40年前因食管癌接受了食管切除术并采用胸骨后胃管重建术。术前进行了多排螺旋计算机断层扫描，以评估胃管以及为胃管供血的胃网膜动脉的走行。经过仔细的胸骨再次切开和充分的解剖后，通过正中胸骨切开术安全地实施了OPCAB，未损伤胃管或导致血流动力学不稳定。患者术后早期过程顺利。
