冠状动脉搭桥内镜大隐静脉获取术136例

Endoscopic greater saphenous vein harvesting during coronary artery bypass operation: Report of 136 cases

目的探讨内镜辅助小切口获取大隐静脉进行冠状动脉搭桥手术的价值。方法411例冠状动脉搭桥手术,依据患者意愿采用微创小切口手术及传统开放大切口手术获取大隐静脉,其中136例应用内镜静脉获取术(endoscop icve in harvesting,EVH),275例应用开放静脉获取术(open ve in harvesting,OVH),比较2组患者手术情况以及下肢切口并发症发生率。结果EVH组下肢切口并发症总发生率为18.4%(25/136),显著低于OVH组36.7%(101/275)(2χ=14.406,P=0.000),其中下肢浮肿、感觉异常、血肿和液化发生率EVH组均低于OVH组,分别为1.5%(2/136)vs.35.3%(97/275)(2χ=56.861,P=0.000)、7.4%(10/136)vs.33.8%(93/275)(2χ=33.937,P=0.000)、16.2%(22/136)vs.27.3%(75/275)(2χ=6.214,P=0.013)和0.7%(1/136)vs.8.7%(24/275)(2χ=10.174,P=0.001)。总手术时间EVH组为(226.3±28.5)m in,OVH组为(224.7±19.2)m in,2组比较差异无显著性(t=0.673,P=0.502)。血管桥早期失功EVH组和OVH组各发生1例,2组比较差异无显著性(2χ=0.000,P=1.000)。远端吻合口数目EVH组(3.6±0.8)个,OVH组(3.3±1.0)个,2组比较差异有显著性(t=3.049,P=0.002),但临床意义不明显。结论内镜大隐静脉获取术可以显著降低高危患者的切口相关并发症,并不增加手术时间和血管桥早期失功发生率,亦不会减少远端吻合口数量而影响冠状动脉的完全再血管化治疗。

Objective To explore the value of endoscopic mini - incision greater saphenous vein harvesting for coronary artery bypass operation. Methods A total of 411 patients scheduled for coronary artery bypass operation were given either endoscopic vein harvesting （EVH Group, n = 136） or open vein harvesting （OVH Group, n = 275 ）, based on patient＇ s willingness. The operation outcomes and incision complications were compared between the two groups. Results The incidence of various incision complications was significantly lower in the EVH Group （ 18.4%, 25/136） than in the OVH Group （36.7% , 101/275） （x^2 = 14. 406, P =0.000）. As compared with the OVH Group, the EVH Group had lower incidences of edema （1.5% vs 35.3% ;x^2= 56.861, P=0.000）, paraesthesia （7.4% vs33.8%;x^2 =33.937, P=0.000）, hematoma （16.2% vs27.3%;x^2=6.214, P= 0. 013） , and incisional liquefaction （0.7% vs 8.7% ; X2 = 10. 174, P = 0. 001 ） of the lower extemity. The total operation time were 226.3 ±28.5 rain in the EVH Group and 224.7 ± 19.2 rain in the OVH Group, without significant difference between the two groups （t = 0. 673, P=0. 502）. Early graft failure happened in 1 case in each of the groups, without significant difference between the two groups （x^2= 0. 000, P = 1. 000）. The numbers of distal coronary anastomoses were 3.6 ± 0.8 in the EVH Group and 3.3 ± 1.0 in the OVH Group, with significant difference （ t = 3. 049, P = 0. 002）. Conclusions Endoscopic greater saphenous vein harvesting can significantly reduce the morbidity associated with incision complications, whereas does not prolong the operative time, increase the incidence of early graft failure, and decrease the number of distal coronary anastomoses.