内窥镜下取小腿大隐静脉用于冠状动脉搭桥的临床效果

Clinical application of endoscopic harvested saphenous vein of lower leg in coronary artery bypass grafting

目的:评价内窥镜下采集小腿大隐静脉,用于非体外循环冠状动脉搭桥术(off pump coronary artery bypass grafting,OPCABG)的临床效果。方法:选取OPCABG患者269例,根据小腿大隐静脉取材方式将患者分为,内窥镜血管采集(endoscopic vein harvesting,EVH)组和全程切开(open vein harvesting,OVH)组,比较两组取材时间、取材质量、切口并发症、围术期和术后近期随访时的临床效果及患者评价。结果:EVH组取材长度、血管质量和取材时间可满足冠状动脉搭桥手术需要。与OVH组相比,EVH组术后切口并发症发生率和下肢水肿发生率显著降低,且差异有统计学意义,但皮下组织瘀斑发生率较OVH组高。取材时间EVH组平均35 min,OVH组平均45 min,差异有统计学意义。远端吻合口数目EVH组3.2个/例,OVH组3.1个/例,差异无统计学意义。两组围术期心肌梗死发生率差异无统计学意义。本研究中,所有患者均痊愈出院,术后平均随访4～5个月,均无心绞痛再发。结论:CABG术中采取EVH取小腿大隐静脉的方法有效可行。其作为一种微创取血管的方法,取材质量良好、切口小、并发症更少,得到了医生和患者的认可。

Objective：To evaluate vessel quality and clinical application of the saphenous vein of lower leg with endoscopic vascular acquisition system in off-pump coronary artery bypass grafting.Methods：269 patients undergoing OPCABG were enrolled for this study,the patients were divided intoendoscopic vein harvesting（EVH） group and open vein harvesting（OVH） group.The harvesting time,vessels quality,wound complications,perioperative and postoperative follow-up clinical efficacy and patient evaluation were compared between two groups.Results：Vascular length,quality and harvesting time in EVH group could meet the demand of coronary artery bypass grafting.Wound complications and edema in EVH group were significantly lower compared to the OVH group and patients of EVH group had a higher incidence of subcutaneous ecchymosis.Average harvesting time was 35 min in EVH group,and 45min in OVH group,the difference was statistically significant.The average number of distal anastomosis was 3.2 in EVH group and 3.1 in OVH group per patient.The incidence of perioperative myocardial infarction was not significantly different between two groups.In this study,all patients were cured as expected and had no angina recurrence with a 4-5 months follow-up.Conclusion：EVH is an effective and feasible way of harvesting lower leg saphenous vein in OPCABG surgery.As a minimally invasive approach,good quality of harvested vessels,small incision and less wound complications with EVH has been recognized.