内镜采集大隐静脉的冠状动脉旁路移植术1573例应用体会

Curative effect observation and experience summary with endoscopic saphenous vein harvesting for coronary artery bypass grafting in 1 573 cases

目的对单中心8年间的1 573例冠状动脉旁路移植术中应用内镜大隐静脉采集术的患者进行疗效观察评估及经验总结。方法回顾性分析2009年1月至2016年4月沈阳军区总医院应用内镜采集大隐静脉的冠状动脉旁路移植术患者,共计1 573例,观察并分析围手术期心肌梗死、术后室颤等与血管桥采集质量相关的术后并发症的发生,同时观察下肢术后疼痛、水肿、切口感染等情况。集中选取2014年3月至5月间连续70例应用内镜采集大隐静脉的冠状动脉旁路移植术患者,于术后1周复查64排冠状动脉CT评估术后近期血管桥通畅情况。结果应用内镜采集的大隐静脉大体质量满意。住院期间死亡患者共18例。其中出现术后围手术期心肌梗死9例,死亡5例;出现术后频发室颤5例,死亡4例;出现术后脑梗死12例,死亡5例;出现4例多脏器功能衰竭,均死亡。术后下肢水肿和切口疼痛明显减轻,切口感染及愈合不良情况明显减少。术后近期血管桥通畅情况理想。结论长时间大样本量的应用,充分证明内镜大隐静脉采集术具有微创、减轻疼痛等优点,加快恢复进程,避免大面积瘢痕形成后导致运动不便,加之远期的美容效果,有效提高患者的生命质量,是一项成熟有效的技术。

Objective Curative effect observation and experience summary with endoscopic saphenous vein harvesting in coronary artery bypass grafting for 1 573 cases in single center between 8 years. Methods A retrospective analysis of the totaling 1 573 cases coronary artery bypass grafting operation with endoscopic saphenous vein harvesting between Jan. 2009 and Apr. 2016 in the General Hospital of Shenyang Military Region. Observation and analysis of the postoperative complications related to Bridge blood vessel acquisition quality just like perioperative myocardial infarction and postoperative ventricular fibrillation, and the lower limb postoperative pain, edema, wound infection and other conditions were observed at the same time. Selected 70 consecutive cases from Mar. to May in 2014 which reviewed with the 64 slice coronary CT imaging at 1 week after operation. Results The quality of acquisition from endoscopic saphenous vein were satisfied. A total of 18 cases of death during hospitalization. There were 9 cases of perioperative myocardial infarction include 5 death cases, 5 cases of frequent ventrieular fibrillation include 4 death cases, 12 cases of cerebral infarction include 5 death cases, 4 cases of multiple organ failure and all died. Postoperative lower extremity edema and wound pain were significantly reduced, and the wound infection and healing were significantly decreased. The patency of vascular bridge is ideal in the near future. Conclusions Endoscopic vessel acquisition is a safe, mature and effective technique. Minimally invasive purposes can be achieved under the premise of vascular acquisition quality. It reduced the wound infection of lower extremity surgery, poor healing, wound pain and local edema. The recovery process was expedited. Action inconvenience caused by large area of scar formation was to avoided. Coupled with long-term cosmetic effect. All above effectively improve the patient＇s quality of life.