内镜采集大隐静脉在CABG术中的应用及组织学评估

Application and histological assess of endoscopic saphenous vein harvesting

目的 观察冠状动脉旁路移植术（CABG）中应用内窥镜采集大隐静脉对减少下肢切口并发症的效果，并通过组织学改变评价其安全性。方法 2003年8月至2005年8月对256例CABG病人使用VasoView5内窥镜系统采集大隐静脉。对常规切开及内窥镜采集的大隐静脉各10例的静脉近端和远端4mm做光镜和电子显微镜检查。结果 全组病人无皮肤切口感染、下肢水肿、淋巴管炎和脂肪坏死等并发症发生。平均获取大隐静脉桥血管2．2支，平均耗时（45±20）d。平均卧床2～3d。光镜和电子显微镜显示的大隐静脉组织学结构差异不显著。结论 CABG应用内窥镜采集大隐静脉能够减少创伤，明显降低术后下肢并发症，尤其对肥胖、糖尿病病人可降低术后感染的发生率，减轻术后下肢切口疼痛，提高病人术后活动能力，减少卧床与住院时间。且内窥镜方法和切开法具有同样的安全性。

Objective To observe the influence of endoscopic harvesting technique on the prevalence of leg-wonnd complications after coronary artery bypass grafting, and to assess histologically the potential trauma to the vein. Methods From August,2003 to August, 2005, 256 patients undergoing CABG had saphenons vein harvested by endoscopic harvesting system. About 4 man proximal and distal vein end segment of 10 patient undergoing endosocopie and conventional harvesting respectively were examined with light and dectro-microscope. Results The mean number of vein grafts of ESVH was 2.2 and the mean endoscopic harvest time was （45 ± 20） minutes. There was no complicatinn （incision infection, edema of lower extremity, lymphangitis and fat necrosis） eceurred. Stay in bed time was 2 ～3 days. There was no differehce in result of light and electro-micrascopy. Condusion Endoscopic vein harvesting in conmary artery bypass grafting can decreases the prevalence of postoperative leg-would infections, postoperative pain, lying time and hospital stay, and increase the postoperative mobility ability, especially in patient with obesity and diabetes mellitos. Furthermore, the endoscopic harvesting technique may do no additional trauma to the saphenous vein.