内窥镜大隐静脉采集术与直视采集术的对比

Endoscopic Saphenous Vein Harvesting versus Open Vein Harvesting Techniques

目的通过对直视下大隐静脉采集方法 (OVH)和内窥镜下采集方法 (EVH)带来的损伤和恢复情况进行对比,探讨内窥镜下大隐静脉采集术是否有益于降低下肢相关并发症的发生。方法回顾性分析333例单纯行冠状动脉旁路移植术(CABG)的冠心病患者,根据大隐静脉采集方法的不同,分为研究组(EVH)和对照组(OVH),对两组患者的年龄、性别、是否合并糖尿病、术后下肢并发症(如皮下血肿、伤口感染等)发生率、术后住院时间、住院费用、桥血管近远期通畅率等进行对比。结果两组年龄、性别、是否合并糖尿病等差异无统计学意义(P>0.05)。研究组伤口愈合不良、伤口感染、下肢疼痛、下肢皮肤麻木感、下肢水肿的发生率等术后并发症显著低于对照组,差异有统计学意义(P<0.05)。两组皮下血肿的发生率、深静脉血栓的发生率差异无统计学意义(P>0.05)。研究组的住院费用显著高于对照组,差异有统计学意义(P<0.05)。两组术后住院时间差异无统计学意义(P>0.05)。两组桥血管近远期通畅率差异无统计学意义(P>0.05)。结论内窥镜下大隐静脉采集术与传统采集方法比较,不影响桥血管的近远期通畅率,能显著减少下肢相关并发症,有助于患者的下肢康复。

Objective To investigate whether endoscopic saphenous vein harvesting（ EVH） reduces leg wound morbidity and improves rehabilitation of lower extremity as compared to open vein harvesting（ OVH）in patients with coronary artery disease. Methods The clinical data of 333 patients who underwent isolated coronary artery bypass graft surgery（ CABG） between January 2007 and December 2011 were retrospectively analyzed. These patients were divided into EVH group（ n = 210） and OVH group（ n = 123）. Parameters including age,sex,with / without diabetes mellitus,leg wound complications rate,postoperative hospital stay,hospitalization expense,and vein graft patency were analyzed. Results The age,sex,with / without diabetes mellitus were not significantly different between two groups（ P〉0. 05）. However,the incidences of leg wound complications,poor wound healing,wound infections, wound pain, wound numbness, and edema of lower extremity were significantly lower in the EVH group than the OVH group（ P〉0. 05）. The ecchymoma and deepvein thrombosis incidences were not significantly different between these two groups（ P〈0. 05）. The postoperative hospital stay showed no significant difference（ P〉0. 05）,while the hospitalization expense was significantly higher in the EVH group than in the OVH group（ P〈0. 05）. There was no statistical difference of vein graft patency（ P〉0. 05）. Conclusion The EVH system is a safe and effective alternative to OVH because it can markedly reduce postoperative leg wound morbidity and the EVH vein graft has good patency.