冠状动脉旁路移植术中内窥镜采集大隐静脉200例经验总结

Experience of 200 cases of endoscopic vein-graft harvesting in coronary artery bypass graft surgery

目的探讨内窥镜采集大隐静脉技术的学习曲线及减少对大隐静脉的损伤、提高移植血管的长期通畅率和临床效果的方法。方法选择2008年8月至2012年12月在广东省人民医院行冠状动脉旁路移植术的患者250例为研究对象,分为经内窥镜采集大隐静脉移植物组(200例)和桥式切开采集大隐静脉移植物组(50例)。比较两组术中大隐静脉损伤情况、手术时间以及术后伤口并发症的发生率。结果在完整学习曲线后,两组大隐静脉直接损伤情况比较,差异无统计学意义[(1.22±0.44)个vs.(1.23±0.51)个,P>0.05];两组手术时间比较,差异无统计学意义[(38±4)min vs.(38±6)min,P>0.05]。经过100例采集经验后,内窥镜组手术时间缩短[(27±4)min vs.(38±6)min,P<0.05];内窥镜采集组术后伤口愈合不良发生率较低(0%vs.22%,P<0.05)、血肿发生率低(0%vs.4%,P<0.05)。结论保证足够的培训期,拥有合理的采集技术下,冠状动脉旁路移植术中内窥镜采集大隐静脉对大隐静脉移植物的直接损伤与桥式切开采集比较无明显差异,但伤口并发症明显减少,手术时间缩短。

Objectives To study the learning curve of endoscopic vein-graft harvesting （EVH） and methods of reducing greater saphenous vein injury and improving long-term patency and clinical outcomes. Methods Totally 250 patients performed coronary artery bypass graft （CABG） from August 2008 to December 2012 in Guangdong General Hospital were included in this study. Patients were divided into endoscopic vein-graft harvesting group （EVH group, n=200） and bridge open vein-graft harvesting （BVH） group （BVH group,n=50）. Vein injury, operation duration and wound complications were compared between the two groups. Results After completing the learning curve, there were no significant differences between the two groups in terms of saphenous vein direct injury [ （1.22±0.44） cases vs. （1.23± 0.51） cases,P〉0.05] and operation duration [（38±4） rain vs. （38±6） min, P〉0.05]. After 100 cases, shorter operation duration [ （27±4） rain vs. （38±6） min, P〈0.05], lower delayed healing （0% vs. 22%, P〈0.05） and hemorrhage occurrence （0% vs.4% ,P〈0.05） were observed in EVH group. Conclusions Sufficient trainings should be guaranteed with reasonable harvesting technique. EVH shows no significant difference with BVH in terms of direct injury to the vein graft, but can significantly lower wound complications and shorten operation duration.