内窥镜采集桡动脉在冠状动脉旁路移植术中的应用及组织学评估

Endoscopic radial artery harvest for coronary artery bypass grafting： applications and histologic assessment

目的观察冠状动脉旁路移植术（CABG）术中应用内窥镜桡动脉采集技术的效果，通过组织学观察评价内窥镜采集桡动脉的安全性。方法2003年8月至2008年6月，87例CABG患者采用VasoView5内窥镜系统采集桡动脉。分别对各10例传统切开及内窥镜采集的桡动脉近端和远端各取4m／n，利用光学显微镜和透射电子显微镜检查进行组织学对照。结果内窥镜采集耗时42～98min，平均耗时（57．6±17．3）min；获取桡动脉长度15—20cm，平均（17．5±1．6）cm；采集的桡动脉无明显损伤，除2例外所有采集的桡动脉都被用于CABG。7例患者术后早期拇指背侧有轻度感觉异常，随访3个月后明显改善。光镜和电子显微镜下桡动脉内膜、中层、外膜的损伤情况与传统切开组相似。结论CABG术中应用内窥镜采集桡动脉可取得良好的外观效果，不损伤桡动脉血管结构，神经损伤可减到最小程度。组织学分析结果证实该方法与传统切开法具有同样的安全性。

Objective To observe the influence of endoscopic radial artery harvesting techniques on the prevalence of complications after coronary artery bypass grafting, and to assess the potential trauma to the radial artery through the histological changes. Methods From August 2003 to June 2008, 87 patients undergoing CABG had radial artery harvested by endoscopic harvesting system. About 4 mm proximal and distal radial artery end segment of 10 patients undergoing endosocopic and conventional harvesting were exammed with light and electro-microscope. Results The endoscopic harvest time was 42 to 98 min, with a mean of （57. 6 ± 17. 3） min. The harvested conduit length was 15 to 20 cm, with a mean of （ 17. 5 ± 1.6） cm. Objective dorsal thenar numbness remained in 7 patients, none complained of forearm numbness at 3- month follow-up. The result of light and electro-microscope had no differences in the intima, media, or adventitia between endoscopically and conventionally obtained radial artery segments. Conclusion The use of endoscopic radial artery harvesting in coronary artery bypass grafting can be performed safely with infrequent complications. This method results in excellent patient satisfaction, particularly regarding the cosmetic outcome.