内窥镜血管采集系统和间断小切口获取大隐静脉在冠状动脉旁路移植术的应用研究

Endoscopy vs.Interrupted Incisions for Saphenous Vein Harvest in Coronary Artery Bypass Graft

目的比较内窥镜和间断小切口获取大隐静脉在冠状动脉旁路移植术(coronary artery bypass graft,CABG)中应用的临床效果。方法 2009年8月～2012年8月,连续651例CABG术中,479例(A组)采用内窥镜血管采集系统,172例(B组)采用间断小切口获取大隐静脉,方法由患者决定。比较两组大隐静脉获取时间、切口长度和术后腿部并发症情况。结果 2组获取大隐静脉均获成功,静脉长度差异无显著性。与B组相比,A组获取静脉时间短[(18.01±3.49)min vs.(27.06±4.26)min,t=-27.417,P=0.000],皮肤切口长度短[(3.49±0.87)cm vs.(12.53±1.41)cm,t=-97.587,P=0.000],术后需要止痛剂、切口愈合延迟、下肢水肿的比例低[2.9%(14/479)vs.37.8%(65/172),χ2=144.303,P=0.000;0(0/479)vs.5.8%(10/172),P=0.000;1.0%(5/479)vs.18.0%(31/172),χ2=69.526,P=0.000],但总住院费用高[(8.54±1.43)万元vs.(6.45±0.91)万元,t=17.893,P=0.000]。结论内窥镜血管采集系统获取大隐静脉安全可行,并发症少,美容效果显著,值得推广。

Objective To compare the efficacy of endoscopy and interrupted incisions for saphenous vein harvest in coronary artery bypass graft （ CABG）. Methods From August 2009 to August 2012, the saphenous veins were harvested for CABG in totally 651 patients, 479 of them received endoscopy （group A） while the other 172 underwent an interrupted-incision procedure （group B）. The harvesting time, length of incision, and postoperative complications in the involved leg were compared between the two groups. Results The procedures were completed successfully in all the patients in the both groups. No significant difference existed in the length of the harvested vein between the two groups. Compared to group B, group A showed significantly shorter harvesting time, smaller incision, and lower rates of postoperative analgesia, delayed wound healing, and leg edema, however significantly higher hospitalization cost [（18.01 ±3.49） minvs. （27.06 ±4.26） rain, t= -27.417, P=0.000; （3.49 ±0.87） cm vs. （12.53 ± 1.41） cm, t=97.587, P=0.000; 2.9% （14/479） vs. 37.8% （65/172）,X2 =144.303, P=0.000; 0 （0/479） vs. 5.8% （10/172）, P=O. O00; 1.0% （5/479） vs. 18.0% （31/172）, X2 =69.526, P =0.000, and （85 400 ± 14 300） RMB vs. （64 500 ± 9 100） RMB, t = 17. 893, P = 0. 000 ]. Conclusions It is safe and feasible to harvest the saphenous vein by endoscopy. We recommend the procedure for its good cosmetic results and low complication rate.