冠状动脉旁路移植术游离大隐静脉1050例无切口感染

Experience of harvesting great saphenous vein without infectious complication in 1050 cases of coronary artery bypass grafting

目的介绍冠状动脉旁路移植术(CABG)游离大隐静脉(GSV)无腿部切口感染的经验.方法在完成1 120例CABG中,游离大隐静脉(GSV)1 050例.搭桥材料常规使用原位带蒂左乳内动脉(LIMA)与左前降支吻合,其余桥采用GSV和(或)桡动脉.采用术前选择合适的GSV、术中程序化的游离方法和恰当的保护措施、术后切口的细致观察和处理,以及合并糖尿病等感染高危因素的控制等围术期综合策略,以避免腿部切口的感染.结果无一例腿部切口感染.2例糖尿病患者切口延迟愈合,创面换药后痊愈;10例术后3～4天切口少量渗液,但无感染,缝合2～3针后痊愈,未延迟出院.大部分患者出现轻度腿部水肿和皮下淤血,个别患者述切口部位感觉麻木.随访3个月～2年,绝大多数术后3个月内感觉恢复正常,水肿消退.结论程序化的GSV游离方法和细致的围术期处理可以避免腿部切口感染.

Objective To introduce experience of harvesting great saphenous vein （GSV） and surgical techniques to avoid infectious complication in coronary artery bypass grafting （CAbG）. Methods One thousand and one hundred twenty CABG, including 523 conventional CABG （CCABG） and 597 off pump coronary artery bypass grafting （OPCAB）, were performed by the same surgical team. One thousand and fifty GSV were used as the conduit. Left internal mammary artery was routinely anastomosed to left anterior descending artery（LAD）, and GSV and/or radial artery to the other target vessels, Preoperative selection of GSV, operative procedure of harvesting, meticulous postoperative supervision and appropriate treatment of the incision, and the control of risk factors as diabetes mellitus, which composed an integral part of periopertive strategies, are critical to avoid infectious complication. Results No infection occurred. Recovery of two patients with diabetes mellitus was complicated by delayed healing of incision. In ten patients there was a slight exudation from the incision, and they healed without infection after the addition of 2-3 interrupted sutures. Healing was not delayed. Swelling of the involved legs occurred in the majority of patients, and numbness along the incision was also documented in some patients, and it usually recovered to normal three months after operation, after being followed-up for 3 months to 2 years. Conclusion Infection can be completely avoided after the planned procedure of harvesting GSV and meticulous perioperative care.