不同方法采集OPCABG术中旁路血管的结果比较

Pathological differences of grafts adopt different harvesting methods for coronary artery bypass grafting

目的通过对比传统切开（openveinharvest，OVH）和内镜获取（endoscopicveinharvest，EVH）两种方法采集的大隐静脉的组织学表现，探讨分析两种采集方法对静脉壁的损伤情况。方法选取2014年9至11月收治的应用大隐静脉作旁路移植材料、择期行非体外循环冠状动脉旁路移植术（OPCABG）的患者20例。根据静脉获取方式分为2组，OVH组和EVH组，每组10例。观察术后切口并发症。石蜡包埋，大隐静脉横断面切片，每组随机取20个标本，分别应用HE、CD31、Desmin、SMA法染色。光镜下观察大隐静脉内膜层、弹力纤维层、平滑肌层以及外膜层，从组织连续性、完整性、均匀一致性评价血管损伤，量化评估结果，统计学分析。结果EVH组患者总术后切口并发症发生率少于OVH组（P〈0．05）。光镜下分别观察大隐静脉内膜层、弹力纤维层、平滑肌层以及外膜层损伤，结果显示各组织层次差异均无统计学意义（P〉0．05）。结论与传统切开法采集大隐静脉相比，内镜辅助采集大隐静脉行OPCABG术后切口相关并发症明显减少。两种术式采集的大隐静脉在组织学损伤程度上无明显差异。临床上采用内镜辅助采集大隐静脉安全可行。

Objective Compare effect of open vein harvest（OVH） and endoscopic vein harvest（EVH） on injury degree of vein wall by features of two methods of harvest of great saphenous veins. Methods Select OPCABG patients during Septem- ber and December on 2014, using great saphenous vein as blood vessel bridge, total number of patients is 20. According to the different methods of venous harvest,20 patients were divided into 2 groups： 10 patients for OVH and 10 patients for EVH. The harvested veins were in line with the conditions of blood vessel bridge. Clinical outcomes were observed ： postoperative wound complications, and the evaluation results of great saphenous vein tissue injury. Great saphenous veins were paraffin embedded sections,20 specimens of great saphenous vein from each group, hematoxylin and eosin-Iraq red, CD31, desmin, SMA, 4 kinds of staining methods stained were applied. Observe the saphenous vein intimal layer, elastic fiber layer, smooth muscle layer and outer membrane layer under the light microscope. Vascular injury was evaluated from the continuity, integrity and u- niformity of the tissue, quantitative assessment results and statistical methods to analyze. Results The incidence of postopera- tive wound complications in EVH group was less than that of OVH group （P 〈 0.05 ）. There was no obvious difference on vas- cular injury of the saphenous vein intimal layer, elastic fiber layer, smooth muscle layer and outer membrane layer under the light microscope. Conclusion EVH method significantly reduces postoperative complications compared with OVH method. There is no significant difference on two kinds of vein harvest on vein injury degree. EVH is clinically feasible and safe.