电视内镜下大隐静脉采集术在老年冠状动脉搭桥术中的应用

Endoscopic technique for greater saphenous vein harvesting in elderly patients undergoing coronary artery bypass grafting

目的介绍老年冠状动脉旁路移植术(CABG)中应用电视内镜采集大隐静脉血管桥的体会。方法纳入自2005年4月至2010年3月择期行老年CABG患者303例,年龄60～84(68.6±7.3)岁。术中在电视内镜辅助下采集大隐静脉血管桥197例(ESVH组),采取全程切开采集大隐静脉(OSVH)106例,ESVH组与OSVH组患者在性别、体质量、在室射血分数、每例搭桥数目、伴发高血压、陈旧性心肌梗死、陈旧性脑梗死、糖尿病与慢性肾功能不全等无显著差异。比较两组的手术效果。结果 ESVH组与OSVH组耗时分别是(38.3±8.8)min和(35.5±7.2)min(P<0.01),ESVH组与OSVH组分别出现皮下血肿8例(4.1%)和2例(1.9%),无显著差异(P>0.05)。ESVH组术后无下肢皮肤感觉异常、脂肪坏死、切口愈合不良并发症,慢性下肢水肿发生率显著低于OSVH组(2.0%vs 19.8%,P<0.05);ESVH组术后下肢疼痛较轻,术后住院时间显著低于OSVH组[(8.4±1.8)vs(13.3±2.8)d.P<0.001]。结论内镜采集大隐静脉桥创伤小,能明显减少老年冠状动脉搭桥术后下肢切口并发症。

Objective To summarize the experiences in greater saphenous vein harvesting during video-assisted endoscopic technique in elderly patients undergoing coronary artery bypass grafting. Methods Between April 2005 and March 2010, 303 elderly patients with coronary heart disease, aged 60 to 84 （68.6±7.3）years, underwent selective coronary artery bypass grafting. Of the 303 patients, 197 cases received video-assisted endoscopic technique for greater saphenous vein harvesting （ESVH）, 106 cases had open procedure for greater saphenous vein harvesting （OSVH）. There was no difference in sex, body mass, left ventricular ejection fraction （LVEF）, the number of bypass grafting and concomitant diseases. The operative efficacy was compared between the two groups. Results The mean operation time duration was （38.3 ±8.8） min and （35.5 ± 7.2） min in ESVH and OSVH groups respectively （P 〈 0.01）. The subcutaneous hematoma occurred in 8 （4.1%） cases and 2 （1.9%） cases in ESVH group and OSVH group respectively （P 〉 0.05）. There was no abnormal feeling, incision infection and fat necrosis of lower extremity in ESVH group. The incidence of chronic leg edema in ESVH group was 2.0%, which was remarkably lower than that in OSVH group （19.8%, P 〈 0.05）. Leg pain in ESVH group was much less intensive than that in OSVH group. The patients receiving ESVH had shorter hospital stay than those receiving OSVH [（8.4 ± 1.8） vs （13.3 ± 2.8） d, P 〈 0.001]. Conclusion ESVH, as a minimally invasive technique, can significantly reduce postoperative leg incision complications in elderly patients undergoing coronary artery bypass grafting.