腔镜获取大隐静脉在糖尿病患者心脏不停跳冠状动脉旁路移植术的应用

Clinical research for patients with diabetes undergoing off-pump coronary artery bypass grafting by endoscopic saphe-nous vein harvesting

目的探讨合并糖尿病（DM）患者心脏不停跳冠状动脉旁路移植手术（OPCAB）中应用腔镜（EVH）获取大隐静脉（SV）临床效果及相关并发症。方法2011年11月至2014年11月，序列对照分析合并DM患者行OPCAB339例的临床资料，其中采用EVH获取SV269例，常规全程切开（CVH）获取SV70例，观察两组患者围手术期病死率、术中SV弃用率、术中大隐静脉旁路血管（SVG）血流量及PI值，术后切口感染、愈合不良、下肢局部血肿、下肢伤口疼痛等并发症发生率，CT冠状动脉造影随访两组部分患者近、中期SVG通畅率。结果围手术期死亡EVH组8例（2．4％），CVH组2例（2．9％）；术中SV弃用率EVH组3．9％，CVH组2．9％；术中SVG整个心动周期的平均血流量EVH组（17．36±11．24）ml／min，CVH组（17．11±8．37）ml／min；PI值EVH组2．78±2．37，CVH组2．22±2．17；术后切口感染率EVH组0，CVH组4．4％；刀口愈合不良率EVH组0．9％，CVH组8．8％；下肢局部血肿率EVH组5．7％，CVH组1．5％；术后3天疼痛视觉类比评分（VAS）EVH组0．53±1．7l，CVH组1．26±2．13；下肢麻木异常感率EVH组9．7％，CVH组22．1％；1周后下肢水肿率EVH组8．5％，CVH组19．1％。术后CT冠状动脉造影随访SVG通畅率，每年两组采用抽签法随机选择20例患者，EVH组60例107支SVG，CVH组60例112支SVG，通畅率分别为1年（91．4％对94．6％）、2年（83．3％对86．1％）、3年（72．2％对73．7％）。结论合并DM患者OPCAB术中应用EVH获取SVG不影响其近、中期通畅率，下肢并发症减少。

Objective To compare clinical effects and complications of patients with diabetes in off-pump coronary ar- tery bypass grafting（OPCAB） between endoscopic saphenous vein harvesting（EVH） and conventional saphenous vein harves- ting（CVI-I）. Methods Sequence comparison analysis the clinical data of 339 patients with DM who underwent OPCAB in our department from Nov 2011 to Nov 2014. 269 cases by EVH ,70 cases by CVH. Observing two groups of patients with deprecated rate of SVG, intraoperative SVG blood flow and the value of PI, lower limb wound complications such as incision infection, poor healing, lower limb local hematoma and pain. SVG patency rate of part patients was follow-up by CT coronary angiogra- phy. Results To compare the two groups of patients by EVH and CVH, the perioperative death was 8 cases in EVH group （2.4%） ,2 cases in CVH group（2.9% ）. The deprecated SVG of patients was 3.9% vs 2.9%. The blood flow was（ 17.36 ± 11.24） ml/min vs（ 17.11±8.37 ） ml/min, PI was 2.78 ± 2.37 vs 2.22 ± 2.17. The incision infection was 0 vs 4.4% , poor healing was 0.9% vs 8.8%. The lower limb local hematoma was 5.7% vs 1.5%. The visual pain analogue scale（VAS） was 0.53± 1.71 vs 1.26 ± 2.13 3 days after operation. The numbness of lower limb was 9.7% vs 22.1%. The Edema of the legs was 8.5% vs 19.1% 7 days after operation. 60 cases were follow-up by CT coronary angiography, the SVG patency rate was91.4% vs 94.6% 1 year after operation, 83.3% vs 86.1% 2 years after operation, 72.2% vs 73.7% 3 years after opera- tion respectively. Conclusion EVH technology for SVG in the patients combined DM has good clinical result, the recent pa- tency rate of SVG is perfect, postoperative limb complications is decreased by EVH.