内窥镜获取大隐静脉行冠状动脉旁路移植的临床研究

Clinical research of endoscopic great saphenous vein harvesting during coronary artery bypass grafting

目的总结内窥镜取静脉（EVH）在冠状动脉旁路移植术（CABG）中应用的临床结果，评价EVH的手术效果。方法2010年9月至2012年10月行择期CABG术的患者862例，根据患者意愿分为EVH组482例和切开取静脉（OVH）组380例。对两组患者术前高危因素和术后并发症进行比较，术后1年复查64排冠状动脉CT，对比两组静脉桥的通畅率。结果两组患者术前下肢切口高危因素比较差异无统计学意义（P〉0．05），但并发症总发生率EVH组（10．2％，49／482）明显低于OVH组（35．0％，133／380），差异有统计学意义（P〈0．05）。两组患者获取静脉长度、静脉获取时间比较差异无统计学意义（P〉0．05）。术后1年EVH组和OVH组分别死亡12，8例，术后静脉桥的通畅率分别为86．0％（404／470）和87．1％（324／372），两组比较差异无统计学意义（P〉0．05）。结论EVH技术在降低术后下肢切口并发症方面有明显优势，特别适用于存在高危因素的患者。内窥镜获取的大隐静脉近期有良好的通畅率。

Objective To summarize the clinical result of patients undergoing endoscopic vein harvest （EVH） technology to collect greater saphenous vein （GSV） in coronary artery bypass graft （CABG） operation, and to assess the operation outcome of EVH. Methods A total of 862 patients underwent primary CABG, among whom saphenous vein of 482 patients were taken using EVH, and the others by open vein harvesting （OVH） based on patients＇ willingness. The operation risk factors and complication were compared between the two groups. The 64 multi-slice computed tomography （64-MSCTA） was used to evaluate the vein grafts patency after surgery for 1 year. The vein patency between the two groups was compared. Results There was no significant difference in risk factors of incision complication between two groups （P 〉 0.05）. But the incidence of various incision complication was significantly lower in EVH group （10.2%,49/482） compared with that in OVH group （35.0%,133/380）（P 〈 0.05）. The time of harvesting and the length of conduits was similar between two groups （P 〉 0.05）. After 1 year＇s follow-up, the vein graft patency were 86.0%（404/470） and 87.1%（324/372） in EVH group and OVH group, and there was no significant difference （P 〉0.05）. Conclusions The decrease in incision complication of EVH is unquestionably superior to those of OVH, especially for those patients with risk factors of incision complication. The EVH vein graft has good pateney in short time.