No-touch技术获取大隐静脉应用于非体外循环冠状动脉旁路移植术单中心经验及近期效果评价

The no-touch great saphenous vein harvesting technique for OPCABG:a single-center experience and short-term clinical outcomes

目的探讨no-touch技术获取大隐静脉应用于非体外循环冠状动脉旁路移植术(OPCABG)的安全性和近期临床效果。方法回顾性分析河南省人民医院心脏中心单一医疗组2018年12月至2020年4月行单纯OPCABG术的117例患者临床资料,其中男91例,女26例;年龄28~79岁,平均(57.45±5.88)岁。按照大隐静脉获取方式,将患者分为no-touch技术获取大隐静脉组(NTSV组,55例)和传统开放式获取大隐静脉组(传统SV组,62例)。评价应用no-touch技术获取大隐静脉用于OPCABG术的可行性、安全性及近期临床效果。No-touch技术获取大隐静脉的方法主要采用瑞典Dr.Souza团队的no-touch技术,处理离体旁路移植血管依据本中心序贯旁路移植及桡动脉的临床应用经验进行一定改进。结果两组患者在高血压、糖尿病、高脂血症、心肌梗死史、室壁瘤形成、左心室收缩功能减低、脑梗塞史、慢性阻塞性肺疾病等合并症方面差异均无统计学意义(P>0.05)。NTSV组男性比例更高(96.4%对61.3%),平均年龄更低(53.49岁对63.76岁),差异均有统计学意义(P<0.01)。两组均在非体外循环心脏不停搏下顺利完成手术,近端优先吻合,在平均旁路移植血管支数、获取大隐静脉时间、手术时间、术后24 h胸腔引流量、库血输注、二次开胸止血、围手术期心肌梗死、院内死亡、ICU停留时间、术后住院时间、下肢切口愈合不良等方面差异均无统计学意义(P>0.05)。术后满1年患者共37例,完成随访36例,其中NTSV组15例,传统SV组21例,随访患者均无心绞痛再发,无院外死亡及其他主要不良心血管事件发生。完成冠状动脉CTA复查26例,NTSV组12例,静脉旁路移植血管通畅率96.4%(27/28);传统SV组14例,静脉旁路移植血管通畅率87.2%(34/39);均无左心室射血分数降低,无再次接受血运重建。结论应用no-touch技术获取大隐静脉安全、可行,不增加手术时间及下肢切口愈合不良发生率,应用于OPCABG术的近期效果优于传统开放式获取大隐静脉。

Objective To study the safety and short-term clinical effect of no-touch technique for harvesting great saphenous vein in off-pump coronary artery bypass grafting(OPCABG).Methods The clinical data of 117 patients in the single medical group who underwent OPCABG from December 2018 to April 2020 were analyzed retrospectively,including 55 patients in the no touch group(NTSV group)and 62 patients in the traditional open access group(traditional SV group).To evaluate the feasibility,safety and short-term clinical effect of using no-touch technique to harvest great saphenous vein for OPCABG.The no-touch technique was mainly based on the invention of Dr.Souza’s team in Sweden.For the treatment of isolated great saphenous veins,some improvements were made according to the clinical experience of the application of sequential bridging and radial artery in our center.Results There were no significant differences between the two groups in hypertension,diabetes,hyperlipidemia,history of myocardial infarction,ventricular aneurysm formation,left ventricular systolic function reduction,history of cerebral infarction,chronic obstructive pulmonary disease and other complications(P>0.05).The NTSV group had higher male proportion(96.4%vs.61.3%)and lower mean age(53.49 years old vs.63.76 years old),and the difference were statistically significant(P<0.01).The patients in the two groups successfully completed the operation without cardiopulmonary bypass,and the proximal anastomosis was the first.There were no statistical significances in the average number of bypass,time to acquire great saphenous vein,operation time,24 h postoperative thoracic drainage,blood bank transfusion,secondary thoracotomy and hemostasis,perioperative myocardial infarction,hospital death,ICU stay time,postoperative hospital stay time,and poor healing of lower limb incision of the two groups.One year after the operation,36 patients were followed up,including 15 patients in NTSV group,and 21 patients in traditional SV group.There was no recurrence of angina pectoris,no out of hospital death and other major adverse cardiovascular events.Among them,26 patients completed CTA reexamination of coronary artery,including 12 patients in NTSV group and 14 patients in traditional SV group,the patency rate of vein bridge was 96.4%vs.87.2%.There was no reduction of left ventricular ejection fraction and no revascularization.Conclusion The method of using no-touch technique to harvest great saphenous vein is safe and feasible.It does not increase the operation time and the incidence of poor healing of lower limb incision.The short-term effect of applying no-touch technique for harvesting great saphenous vein to OPCABG is better than the traditional open way.