内窥镜获取大隐静脉在冠状动脉旁路移植术中的中期效果分析

Mid-term outcome of endoscopic greater saphenous vein harvesting in coronary artery bypass grafting

目的探讨内窥镜获取大隐静脉在冠状动脉旁路移植术中的中期临床效果。方法选取2012年7月～2013年4月在郑州大学第一附属医院心外科接受不停跳冠状动脉旁路移植术的205例患者为研究对象。内窥镜获取大隐静脉（EVH）66例为研究组,男性35例,女性31例,年龄60.30±7.92岁,体质量69.77±10.66 kg;同期行开放获取大隐静脉（OVH）的139例为对照组,男性109例,女性30例,年龄59.20±8.37岁,体质量71.16±9.91 kg。结果 205例患者均顺利完成手术。EVH组围术期死亡2例,死亡率为3.03%;OVH组死亡5例,死亡率为3.60%,两组围术期死亡率差异无统计学意义（P=1.00）。OVH组围术期发生急性心梗3例,发生率为2.16%,EVH组1例,发生率1.52%,亦无统计学差异;低心排综合征OVH组4例（2.88%）,EVH组2例（3.03%）,无统计学差异。术后随访OVH组有8例再发心绞痛,发生率为8.80%;EVH组5例,发生率为8.06%,差异无统计学意义（P=0.93）。两组患者随访期间均无再发心梗;2年静脉桥血管通畅率,OVH组为83.59%,EVH组为82.22%,差异也无统计学意义（P=0.73）。结论 EVH在减低术后下肢伤口并发症上具有明显的优势,中期通畅率同常规手术组无统计学差异,而远期临床效果仍需进一步临床随访研究。

Objective To evaluate the mid- term clinical outcome of endoscopic greater saphenous vein harvesting（EVH） in coronary artery bypass grafting（CABG）. Method A total of 205 patients receiving off- pump CABG between July, 2012 and April, 2013 at our department were enrolled in this study, including 66 patients（35 male and 31 female patients with a mean age of 60.3 ± 7.92 years） undergoing EVH and 139 patients（109 male and 30 female patients with a mean age of 59.20 ± 8.37years） undergoing open greater saphenous vein harvesting（OVH）. Results The surgical procedures were completed smoothly in all the cases. The perioperative mortality rates was 3.03%（2/66） in EVH group, as compared with 3.60%（5/139） in OVH group（P=1.00）. Acute myocardial infarction（AMI） occurred during the perioperative period in 3（2.16%） patients in OVH group and in 1（1.52%） patient in EVH group. Perioperative low cardiac output syndrome was diagnosed in 4（2.88%） patients in OVH group and in 2（3.03%） in EVH group（P〈0.05）. During the follow-up, 8（8.80%） patients in OVH group and 5（8.06%）in EVH group had recurrent angina（P=0.93）. No patients experienced AMI during the follow- up. The 2- year patency rate of the venous grafts was 83.59% in OVH group and 82.22% in EVH group（P=0.73）. Conclusion EVH has significant advantage in reducing the complications of the incision in the lower limbs. The mid-term patency rates of venous grafts are similar between OVH and EVH, but the long-term patency rate needs further evaluation.