不接触获取大隐静脉技术应用于冠状动脉旁路移植术的临床效果分析

Clinical outcome of no-touch harvesting technique for the great saphenous vein in coronary artery bypass grafting

目的评价不接触获取大隐静脉技术(no-touch saphenous vein grafting,NT-SVG)与传统获取大隐静脉技术(conventional saphenous vein grafting,CV-SVG)应用于冠状动脉旁路移植术的效果。方法2018年1月~2020年12月,应用NT-SVG或CV-SVG同期行CABG术的病人238例,NTSVG组112例,CV-SVG组126例。比较两种获取方式术后并发症和大隐静脉桥血管通畅情况。结果NT-SVG组术后3个月大隐静脉桥血管闭塞率为2.5%,CV-SVG组为6.5%,两组比较,差异有统计学意义(P<0.05),NT-SVG组术后12个月大隐静脉桥血管闭塞率为4.2%,CV-SVG组为9.0%,两组比较,差异有统计学意义(P<0.05)。NT-SVG组和CV-SVG组术后30天内死亡率分别为0.9%和0.8%,二次开胸止血率分别为0.9%和1.6%、心肌梗死率分别为0和0.8%,脑部并发症发生率分别为0.9%和0,肺部感染发生率分别为6.25%和6.3%,肾衰竭需要透析比例分别为1.8%和2.4%,消化道出血发生率分别为0.9%和1.6%,两组比较,差异无统计学意义(P>0.05)。NT-SVG组腿部伤口愈合延迟发生率7.1%,腿部皮肤感觉异常发生率18.8%,CV-SVG组分别为1.6%和9.5%,两组比较,差异有统计学意义(P<0.05)。结论NT-SVG组较CV-SVG组术后3个月和12个月大隐静脉桥通畅率明显提高,术后主要严重并发症无明显增加。

Objective To evaluate the application effect of no-touch saphenous vein grafting(NT-SVG)versus conventional saphenous vein grafting(CV-SVG)in coronary artery bypass grafting(CABG).Method From January 2018 to December 2020,the clinical data of NT-SVG group(112 cases)and CV-SVG group(126 cases)were retrospectively analyzed,and post-complications and patency of SVG were evaluated.Result Venous graft occlusion was 2.5%in the NT-SVG group and 6.5%in the CV-SVG group at 3 months postoperatively(P<0.05),and 4.2%versus 9.0%at 12 months,respectively(P<0.05).There were no significant differences in the incidence of mortality(0.9%vs 0.8%),hemostasis rate of secondary thoracotomy(0.9%vs1.6%),myocardial infarction(0 vs0.8%),brain complications(0.9%vs 0),pulmonary infection(6.25%vs 6.3%),renal failure requiring dialysis(1.8%vs 2.4%),and gastrointestinal bleeding(0.9%vs 1.6%)between the two groups within 30 days after surgery(P>0.05).The incidence of delayed wound healing in the NT-SVG group was 7.1%,and paresthesia in the legs was 18.8%,which were higher than those in the CV-SVG group(1.6%and 9.5%,respectively,P<0.05).Conclusion Compared with the CV-SVG group,the patency rate of SVG was significantly improved in the NT-SVG group at 3 months and 12 months after the operation,and there was no significant increase in major postoperative complications.