内窥镜下采集大隐静脉作为冠状动脉旁路移植手术序贯桥的近期疗效

One year follow up study of sequential saphenous vein grafts harvested by endoscopy

目的评价内窥镜下采集大隐静脉作为序贯桥血管的近期临床效果。方法回顾性分析应用静脉序贯桥行非体外循环冠状动脉旁路移植手术(OPCAB)并完成随访的241例患者的临床资料,根据大隐静脉取材方式将患者分为内窥镜静脉采集(EVH)组85例和开放静脉采集(OVH)组156例,比较2组术后1年时下肢水肿范围、患者满意程度评分、临床预后(死亡、新发心肌梗死、再血管化)、桥血管通畅率。结果 2组性别、年龄、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、陈旧心肌梗死、高血压、左主干病变等比较差异无统计学意义(P>0.05),而EVH组体质量指数、糖尿病比例高于OVH组,差异有统计学意义(P<0.05)。与OVH组比较,EVH组序贯桥血管支数、序贯桥主干流量、主干搏动指数、每支桥血管流量和每支桥搏动指数等差异无统计学意义(P>0.05)。EVH组手术下肢水肿比例和程度均降低、患者满意度提高(P<0.05)。2组术后1年新发心肌梗死、再血管化及桥血管通畅率差异无统计学意义(P>0.05)。结论 CABG术中采取EVH采集小腿大隐静脉作为序贯桥血管能有效降低下肢水肿,提高患者满意度,但并不影响序贯静脉桥1年通畅率。

Objective To evaluate the short term clinical effects of sequential saphenoas vein graft harvested by endoscopy. Methods Retrospectively analyzed 241 patients who received off pump coronary artery bypass grafting ahd finished the one year follow up with sequential saphenous vein graft from Aug 2011 to Nov 2012. Based on vein harvesting rhethods, the patients were divided into endoscopic vein harvesting group （EVH） and open vein harvesting group （OVH）, The compared items included edema area in the lower limbs, patients＂ satisfaction score, clinical outcomes （myocardial infarction and revascularization） and graft p^tency. Results There were no significant differences of 2 groups of gender, age, LVEF, LVEDD, old myocardial infarction, hypertension, left main disease （ P 〉 0. 05 ） , while in EVH group, body mass index, diabetes is higher than the OVH group, the difference was statistically significant （ P 〈 0.05 ）. Compared with OVH group, there were no significant sequential grafts count, sequential bridge, main trunk flow pulsatility index, blood flow of each bridge and a bridge pulsate index with EVH group （ P 〉 0.05）. In EVH group, the satisfaction of operation were improve and lower~ extremity edema ratio decreased （ P 〈 0.05 ）. After 1 years, new myocardial infarction, revascularization and thd^patency. rates did not show statistically significant among the 2 groups （ P 〉 0.05）. Conclusion Sequential saphenous vein graft har- vested via EVH during off pump CABG can effectively reduce lower limb edema and improve patient＇ satisfaction wiihout affecting graft patency one year after the surgery.