腔镜获取大隐静脉的临床学习曲线研究

Learning curve of endoscopic saphenous vein harvesting

目的 了解没有任何经验的手术团队是如何完成完全内窥镜静脉获取（EVH）,以及分析它的学习曲线.方法 回顾性分析2014年11月至2015年11月期间我院连续在冠状动脉搭桥术中应用内窥镜获取大隐静脉240例的临床资料.每连续30例患者为一组（G1～G8）,分别记录每组获取大隐静脉切口数量、获取静脉长度、获取时间、修补数量、转为开放比例及静脉搭桥支数,并计算长度/时间比值.结果 患者平均年龄（63.5±10.1）岁,男性占74.2％,30.0％合并糖尿病,肥胖患者占17.9％,EF＜45％的患者占14.1％;各组患者术前资料比较未见统计学差异.患者平均有（2.44±0.59）个切口,所获取血管长度为（43.6±7.3）cm,所需时间为（62.3±15.7）min,平均搭桥支数为（1.96±0.46）支,长度/时间比值为（0.75±0.23）cm/min.结论 内窥镜获取大隐静脉在CABG中的应用是一个可行的手术方法,即使没有内窥镜经验的医生也可完成.但这需要一个培训周期,我们认为大约60例.

Objective The aim of this study was to review the feasibility of this method, its learning curve, and changing results in a group without previous experience in this procedure. Methods Between Novem- ber 2014 and November 2015, 240 patients for coronary artery bypass grafting underwent EVH, by two operators. Results were reported based on time of harvesting, length of conduits, technical details, and divided into eight groups of 30 consecutive patients each. Results Patient demographics were as follows： 74.2% were male, aged （63.5±10.1）years, with diabetes mellitus in 30.0%, obesity in 17.9%, and EF〈45% in 14.1%. Patients received an average of （2.44±0,59）incisions and obtained conduits had a mean length of （43.6±7.3）cm. The number of venous bypasses per patient was 1.96±0.46. Mean time of EVH was （62.3±15.7）minutes, with a length-time index of 0.75±0.23. Primary success was achieved in 96.7%, with crossover to open technique in 3.3%. Conclusion Endoscopic vein harvesting is a feasible and reproductible method, with a typical learning curve, and unquestion- able benefits for coronary artery bypass graft patients.