不接触技术取大隐静脉在冠状动脉旁路移植术中的疗效分析与技术体会

Efficacy analysis and technical experience of taking saphenous vein graft in CABG by no-touch principle

目的总结应用不接触(no-touch)技术截取的大隐静脉(SVG)在冠状动脉旁路移植术(CABG)中的近期效果与手术技术总结.方法选取2017年1月至2018年10月在郑州市第七人民医院行CABG患者,常规技术取SVG行CABG共99例,为常规组;no-touch技术取SVG行CABG共97例,为no-touch组.比较两组手术资料以及手术治疗效果和围术期并发症发生率差异性,比较1年后桥血管(左乳内动脉和SVG)通畅率差异性.结果①两组患者手术时间、呼吸机辅助时间、重症监护室时间、引流量、下肢伤口愈合率、疼痛评分、心肌损伤指标等比较差异无统计学意义;常规组新发心房颤动发生率显著高于no-touch组(29.29%比19.59%,P<0.05).②两组左乳内动脉通畅率比较差异无统计学意义;no-touch组SVG通畅率显著高于常规组(93.57%比79.86%,P<0.05).结论No-touch技术截取的SVG不增加手术风险与创伤,且能够提高CABG术后中期通畅率.

Objective To summarize the rcent ffects and surgical techniques of the saphenous vein graft captured by no-touch technique in CABG.Methods From January 2017 to October 2018 in Zhengzhou NO.7 Pecople's Hospital,a total of 99 cascs were taken from the saphenous vein graft by conventional techniques for CABG,which was as the conventional group,and a total of 97 cases were taken from the saphenous vein graft by no-touch technique as no-touch group.The operative data,operative therapeutic ffect and perioperative complications and the patency rate of bridge vessels(LIMA and SVG)after 1 year were compared between the two groups.Results(1)There was no significant difference between the two groups in operation time,ventilator assisted time.icu time,drainage volume.lower limb wound healing rate,pain score amd myocardial injury index.etc.The incidence of new atrial fibillation in the conventional group was significantly higher than that in the no-touch group(29.29%vs.19.59%,P<0.05).(2)There was no significant difference in the patency rate of internal mammary artery between the two groups.The SVG patency rate in the no-touch group was significantly higher than in the group(93.57%vs.79.86%.P<0.05).Conclusion The saphenous vein graft extracted by no-touch technique does not increase the risk of surgery or trauma and it can improve the patency rate of CABG in the middle period after the operation.