内镜大隐静脉获取术学习曲线研究

Initial experience and learning curve of endoscopic saphenous vein harvesting

目的研究初学者学习内镜大隐静脉获取术(EVH)的可行性及学习曲线。方法选自2008年1月至2010年2月行择期冠状动脉旁路移植术的患者120例行内镜大隐静脉获取术,按手术时间分为6组,各20例患者。比较获取时间、静脉长度、手术结果等情况。结果本研究长度-时间指数由G_1组的0.41±0.08显著提高到G_6组的0.85±0,03,这一变化也就代表了微创内镜大隐静脉获取术(EVH)的学习曲线。下肢伤口并发症的发生率及切口数随着手术例数的积累呈下降趋势,静脉修补个数无差异和组织学评估结果均证实所获取的静脉质量可靠。结论 EVH作为一种新兴技术有着广泛的应用前景,经80～100例的学习之后即可熟练掌握,满足临床实践的需要。

Abstract： Objective The aim of this study was to prove the feasibility and to obtain the learning curve of the endoscopic saphenous vein harvesting （EVH）, performed by a senior intern without any experience in this procedure. Methods Between January 2008 and February 2010, 120 patients underwent coronary artery bypass grafting with EVH procedure performed. Timing of harvest, length of conduits, clinical outcomes were recorded respectively. 120 patients with EVH procedures were divided into 6 groups, 20 of each. Results The length-time index were 0.41 ± 0.08 in the G1 and 0.85 ± 0.03 in the G6, with significant difference. That means the typical learning curve of EVH. The number of incisions and major wound complications were degressive gradually with the increase of the patients, and two patients crossed to open technique in the early. No difference in the number of repairs and result of electro-microscopy among groups suggested that there were no evidence of initial injury of saphenous vein. Conclusions The EVH procedure is a feasible and reproducible method. But for surgeons without experience in tins kind ot procedure, it implies a training period, as considered in our series of at least 80 - 100 patients. The learning curve means change of the length-time index. At the beginning of learning curve, there were more possibility of crossing to OVH and higher incidence rate of wound complications, but there was a reduction in complication rate as cases increased.