优势
The benefits of 微创冠脉搭桥术 over traditional surgery include the following:
- 更少的痛苦
- 降低感染和其他手术并发症的风险
- 降低中风和心律失常的风险
- 减少失血量，减少输血需求
- 手术时间短，麻醉时间短
- 缩短住院时间
- 更快的恢复时间，更快地恢复正常活动
- 美观效果更好(疤痕更小)
谁会受益
Most candidates for bypass surgery stand to benefit from this minimally invasive option. That's especially true for patients at higher risk from open-heart surgery because of age, 虚弱或其他健康状况，如肥胖, diabetes and chronic obstructive pulmonary disease (COPD) – or because they are immunocompromised.
然而，这种手术并不适用于所有的搭桥病人. 既往胸部或肺部手术, 胸部放射治疗, or intrapleural chemotherapy can leave adhesions and scar tissue that can complicate the ability to access the heart. 但这些并不是绝对的禁忌症. We make our decisions on a case-by-case basis after a full evaluation.
评价
Your doctor will decide whether you're a candidate for 微创冠脉搭桥术 based on a number of factors, 包括:
- 心脏病症状的出现和严重程度
- 冠状动脉阻塞的严重程度和部位
- 你对其他治疗的反应
- 你的生活质量
- 你还有其他健康问题吗
The evaluation process is much the same for 微创冠脉搭桥术 as for the traditional surgery. Your doctor will perform a physical exam focused on your cardiovascular system. 将进行测试以找出哪些动脉堵塞了, 堵塞的范围和位置, 以及你的心脏是否受损. 这些测试包括:
- 心电图 (EKG) – This simple test detects and records your heart's electrical activity. 它被用来帮助检测心脏问题并确定其根源.
- 血管造影-导管(细), flexible tube) is inserted into a blood vessel (usually in the groin area) and threaded through to the heart. A dye is injected through the catheter and special X-rays track the blood flow through your heart and arteries. The scan shows where the blockages are and whether your blood vessels are healthy and large enough to support a bypass.
- 左心导管 -这与血管造影类似，可以代替血管造影. A catheter is threaded through blood vessels to the heart and arteries, and dye is injected. The resulting X-ray images highlight blood flow through the arteries, allowing the doctor to locate blockages and determine whether your arteries are in good enough shape to support a bypass.
- 经胸廓的超声心动图 (TTE) -在无创超声扫描中, the transducer (the device emitting sound waves to produce images of your heart) is held against your chest. The test provides information about how well your heart valves and chambers are working and how blood is moving through.
- Arterial mapping – An ultrasound evaluation that is used to obtain detailed pictures of radial arteries (in the forearm) that may be used as bypass grafts. The graft vessels are obtained through an endoscopic technique that requires only a tiny incision at the wrist.
过程
手术持续两个半小时到三个半小时. 你处于全身麻醉状态(完全睡着了). 治疗你的团队包括你的心胸外科十大赌博平台排行榜, 麻醉师, 其他的十大赌博平台排行榜, 和护士. If your doctor decides you need the support of a heart-lung machine, a perfusionist (a heart-lung bypass machine specialist) will also be present.
The surgeon makes a 2- to 2½-inch incision between ribs on the left side of the chest. 通过切口插入专门的手术器械, 还有一个内窥镜, 装有照相机的管子, 这样十大赌博平台排行榜就能看到你的胸腔了吗. 该区域的肌肉被推开. The surgeon finds and prepares an artery on the chest wall (the internal mammary arteries) and then attaches it to the affected coronary artery, 就在堵塞之后. 如果有不止一条动脉堵塞，这个过程就会重复. Once all the bypasses are connected, the instruments are withdrawn and the incision is closed.
病人 with weak or dilated hearts may need to be on a heart-lung bypass machine during the surgery. However, the heart is not stopped, as it is in the traditional procedure. Your doctor will let you know ahead of time whether this is necessary.
复苏
手术后的18到24小时, 你在心脏重症监护病房, 在那里我们可以密切监测你的情况. 然后你会被转移到一个普通的病房再呆一天左右. 大多数病人术后3天出院. 你会收到关于如何在家照顾自己的指导.
One of the biggest advantages of 微创冠脉搭桥术 is the short recovery time. Most patients are free to move as they wish – they can even drive as soon as they leave the hospital. Most are cleared for all normal physical activities in 10 to 15 days, 而传统CABG的恢复需要三到四个月.
与传统的冠脉搭桥一样，患者也能获得良好的效果. 许多人多年来都没有症状, though clogs can develop in the grafted arteries or in arteries that weren't previously blocked. 生活方式的改变和药物治疗可以帮助预防新的堵塞.
风险
The minimally invasive procedure reduces the likelihood of some of the most common complications of traditional CABG. 因为切口更小，没有骨头被切开, the risk of bleeding during or after 微创冠脉搭桥术 is lower. There's less risk of stroke or atrial fibrillation because the heart is not stopped. 此外，较小的切口减少了感染的机会.
The less common risks are about the same for the two approaches to CABG. 这些可能性包括肺炎或呼吸问题, 胰腺炎, 肾功能衰竭和移植物衰竭.
