Uchida N, Kawaue Y
Department of Cardiovascular Surgery, Hiroshima General Hospital, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1995 Jun;43(6):841-6.
We discussed upper abdominal complications after 161 coronary artery bypass graftings using right gastroepiploic artery (RGEA). We had one case of bleeding from RGEA branches (1), one case of pyrolus stenosis because of anterior stomach pressed by RGEA (2), three cases of gastric ulcer (3) (three cases with a past history of gastric ulcer, two case with IABP) and one case of gastric perforation (4) as early postoperative complications. As long-term postoperative complications, we had two cases of abdominal hernia (5) and two cases of gastric cancer (6). The cases of number 1, 2 and 3 are solvable because these are technical problem. As concerns gastric mucosal ischemic complications (3.4), long-term antiulcerative medication was required for the patients with gastric ulcer as a past history or with IAPB, RGEA should not be used in case of bad general condition. And as far as gastric cancer is concerned, frequent gastric fiberscopic examinations are necessary after CABG using RGEA for the purpose of finding out early gastric cancer until we can perform culative gastrectomy without cutting RGEA.
我们讨论了161例使用胃网膜右动脉(RGEA)进行冠状动脉搭桥术后的上腹部并发症。术后早期并发症包括1例RGEA分支出血(1)、1例因RGEA压迫前胃导致的幽门狭窄(2)、3例胃溃疡(3)(3例有胃溃疡病史,2例使用主动脉内球囊反搏)和1例胃穿孔(4)。术后长期并发症包括2例腹疝(5)和2例胃癌(6)。第1、2和3例情况可解决,因为这些是技术问题。对于胃黏膜缺血性并发症(3、4),有胃溃疡病史或使用主动脉内球囊反搏的患者需要长期服用抗溃疡药物,全身状况不佳时不应使用RGEA。就胃癌而言,在使用RGEA进行冠状动脉搭桥术后,有必要频繁进行胃纤维镜检查,以便在能够在不切断RGEA的情况下进行累积性胃切除术之前发现早期胃癌。