动脉旁路术前自体大隐静脉移植物的评估

Preoperative evaluation of autogenous vein grafts

目的 研究动脉旁路术前自体大隐静脉移植物的评估方法。方法 应用静脉造影和双功彩超对动脉旁路术前的自体大隐静脉移植物进行评估 ,并与术中测量结果进行比较。应用双功彩超对年轻对照组、老龄对照组及动脉粥样硬化组的自体大隐静脉进行检测 ,并计算它们的管径和弹性顺应性。结果 大隐静脉造影测定的管径低于术中直接测定的管径值 (P <0 .0 5 )。双功彩超评估大隐静脉 ,在平卧时测得的管径最小 ,站立时静脉明显扩张 ,充血试验时测得的管径最大 ,以年轻对照组最为明显。动脉硬化组在站立位和充血试验时超声测得的大隐静脉管径与术中探查测得的管径无明显差别 (P >0 .0 5 )。年轻对照组弹性顺应性最好 ,老年对照组和动脉硬化组的弹性顺应性无明显差别 ( P >0 .0 5 )。结论 双功彩超采用合适的体位与方法可正确地评估大隐静脉的管径 ,通过测定大隐静脉的弹性顺应性可对其质量进行评估。

Objective To explore methods of evaluating autogenous vein grafts.Methods Preoperative atherosclerotic patients underwent greater saphenous vein duplex mapping and venography,their maximal internal vein diameters were compared with those of operative detection.Three groups of patients were prospectively studied by duplex:younger control subjects,older control subjects and preoperative atherosclerotic patients,we measured the greater saphenous vein diameters and vein compliance.Results Venography underestimated the greater saphenous vein diameters(P<0.05).Three groups patients had such increase in vein diameter with any positional change from the supine position to standing with duplex,a high-thigh tourniquet had largest vein diameters in three groups patients,especial for younger control subjects.The greater saphenous vein diameters with duplex in standing and high-thigh tourniquet had no significantly difference from that of operative detection(P>0.05).Younger control subjects had better vein compliance,but vein compliance of older control subjects had no significantly difference from that of preoperative atherosclerotic patients(P>0.05).Conclusion The duplex can accurately measure the greater saphenous vein diameters by optimal positions and techniques,it can evaluate quality of the greater saphenous vein by measuring vein compliance.