冠状动脉旁路移植术中联合应用内窥镜采集大隐静脉和直视采集桡动脉与单纯应用内窥镜采集大隐静脉的比较

Comparison of endoscopic saphenous vein combined with open radial artery harvesting and isolated endoscopic saphenous vein harvesting during coronary artery bypass grafting

目的:探讨内窥镜采集大隐静脉联合直视采集桡动脉在冠状动脉旁路移植术中的应用效果。方法:2009年1月至2010年6月,35例冠状动脉旁路移植患者联合应用内窥镜采集大隐静脉(EVH)和直视桡动脉采集(联合组),同期28例患者单纯应用EVH(单纯组)。对比两组患者搭桥支数、切口并发症、采集大隐静脉时间、采集大隐静脉长度,采集移植血管长度,采集移植血管时间。结果:两组患者搭桥支数[联合组(3.56±0.76)支,单纯组(3.48±0.82)支,P=0.78]和切口并发症(联合组17.1%,单纯组14.3%,P=0.61)均无明显差异。联合组采集大隐静脉长度较单纯组显著短[联合组(23.6±3.4)cm,单纯组(42.1±7.2)cm,P<0.001],采集大隐静脉时间显著较单纯组少[联合组(33.2±10.8)min,单纯组(44.3±11.4)min,P<0.001]。联合组采集桡动脉血管长度(17.5±2.6)cm,耗时(36.5±6.7)min。两组采集移植血管长度无明显差异[联合组(43.4±6.1)cm,单纯组(42.1±7.2)cm,P=0.82],采集移植血管时间联合组明显少于单纯组[联合组34.1±8.7)min,单纯组(44.3±11.4)min,P<0.001]。结论:在冠状动脉旁路移植术中联合内窥镜采集大隐静脉和直视采集桡动脉,减少了内窥镜采集大隐静脉的长度,缩短了手术时间,有较好的临床应用价值。

Objective To evaluate the potentials of endoscopic saphenous vein combined with open radial artery harvesting during coronary artery bypass grafting （CABG）. Methods From January 2006 to June 2009, thirty-five patients were performed endoscopic saphenous vein combined with open radial artery harvesting during CABG, and 28 patients were performed using the isolated endoscopic technique. Clinical results of these two groups were nalyzed. Results The postoperative wound complications （17.1% in combined group versus 14.3% in isolated group,P= 0.61） and the number of grafts （3.56 ± 0.76） in combined group versus （3.48 ± 0.82） in isolated group, P = 0.78） were similar between these two groups. However, the vein length （23.6 ± 3.4） cm in combined group versus （42.1 ± 7.2） cm in isolated group, （P 〈 0.001 ） and the operation time （33.2 ± 10.8） rain in combined group versus （44.3 ± 11.4） rain in isolated group, （P 〈 0.001 ） of vein harvesting in combined group were much less than those in isolated group. The total conduit length was similar between these two groups （43.4 ± 6.1 ） cm in combined group ve （42.1 ± 7.2） cm in isolated groui3,P = 0.82）, but, the procedure time （35.1 ± 8.7） rain in combined group versus （44.3 ± 11.4） rain in isolated group, （P 〈 0.001 ） in Combined group was shorter than that in isolated group. Conclusion This combined procedure decreases the harvested saphenous vein lengths and reduce the operation time, revealing a promising perspective in clinical practice.