王刚,张涛,李建,王丽君,王静,谢爱平

• 1:青岛阜外医院心脏中心

摘要(Abstract)：

目的分析比较内窥镜与传统开放式获取大隐静脉应用于冠状动脉旁路移植术(CABG)的早期临床效果。方法纳入2010年3月至2013年1月298例采用内窥镜静脉采集法(EVH)行CABG的患者(EVH组),并与同期309例采用传统切开静脉采集法(CVH)行CABG的患者(CVH组)进行比较,对比两组患者术前资料、手术情况和术后并发症。结果两组患者在获取静脉时间、获取静脉长度、静脉桥数、总手术时间、术后住院时间以及切口感染或延迟愈合、切口血肿、局部皮肤坏死、皮炎发生率等方面比较,差异均无统计学意义(均P>0.05);而EVH组患者住院期间腿部疼痛(17.4%比51.1%,P=0.000)、住院期间腿部水肿(0.7%比32.7%,P=0.000)及淋巴漏(0比7.4%,P=0.000)发生率均显著低于CVH组,差异有统计学意义。结论 CABG术中应用EVH能够显著减轻创伤,降低术后并发症的发生率。

关键词(KeyWords)： 内窥镜;大隐静脉;冠状动脉旁路移植术

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 王刚,张涛,李建,王丽君,王静,谢爱平

参考文献(References)：

• [1]蒙炜,石应康,程述森,等.冠状动脉旁路移植术166例临床分析.中国胸心血管外科临床杂志,2007,14(4):312-313.
• [2]Eagle KA,Guyton RA,Davidoff R,et al.ACC/AHA 2004guideline update for coronary artery bypass graft surgery:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines(Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery).Circulation,2004,110(14):e340-e437.
• [3]Allen KB,Heimansohn DA,Robison RJ,et al.Risk factors for leg wound complications following endoscopic versus traditional saphenous vein harvesting.Heart Surg Forum,2000,3(4):325-330.
• [4]Allen K,Cheng D,Cohn W,et al.Endoscopic vascular harvest in coronary artery bypass grafting surgery:a consensus statement of the International Society of Minimally Invasive Cardiothoracic Surgery(ISMICS)2005.Innovations(Phila),2005,1(2):51-60.
• [5]Carpino PA,Khabbaz KP,Bojar M,et al.Clinical benefits of endoscopic vein harvesting in patients with risk factors for saphenetomy wound infections undergoing coronary artery bypass grafting.J Thorac Cardiovasc surg,2000,119(1):69-76.
• [6]Aziz O,Athansiou T,Panesar SS,et al.Does minimally invasive vein harvesting technique affect the quality of the conduit for coronary revascularization.Ann Thorac Surg,2005,80(6):2407-2414.
• [7]Cable DG,Dearani JA,Pfeifer EA,et al.Minimally invasive saphenous vein harvesting:endothelial integrity and early clinical results.Ann Thorac Surg,1998,66(1):139-143.
• [8]Meyer DM,Rogers TE,Jessen ME,et al.Histologic evidence of the safety of endoscopic saphenous vein graft preparation.Ann Thorac Surg,2000,70(2):487-491.
• [9]Wengrovitz M,Atnip RG,Gifford RR,et al.Wound complications of autogenous subcutaneous infrainguinal arterial bypass surgery:predisposing factors and management.J Vasc Surg,1990,11(1):156-163.
• [10]Kan CD,Luo CY,Yang YJ.Endoscopic saphenous vein harvest decreases leg wound complication in coronary artery bypass grafting patients.J Card Surg,1999,14(3):157-162.
• [11]Davis Z,Jacobs HK,Zhang M,et al.Endoscopic vein harvest for coronary artery bypass grafting:technique and outcomes.J Thorac Cardiovasc Surg,1998,116(2):228-235.
• [12]Carpino PA,Khabbaz KR,Bojar RM,et al.Clinical benefits of endoscopic vein harvesting in patients with risk factors for saphenectomy wound infections undergoing coronary artery bypassgrafting.J Thorac Cardiovasc Surg,2000,119(1):69-75.
• [13]Alrawi SJ,Balaya F,Raju R,et al.A comparative study of endothelial cell injury during open and endoscopic saphenectomy:an electron microscopic evaluation.Heart Surg Forum,2001,4(2):120-127。
• [14]Black EA,Guzik TJ,West NE,et al.Minimally invasive saphenous vein harvesting:effects on endothelial and smooth muscle.Ann Thorac Surg,2001,71(5):1503-1507.
• [15]张冬成,郭琳锐,曹嘉湘,等.腔镜下获取大隐静脉在冠状动脉搭桥术中的应用.国际医药卫生导报,2003,9(5b):4-6.
• [16]Simek M,Marcián P,Bruk V,et al.Endoscopic radial artery harvesting for coronary arterybypass grafting:first experience.Rozhl Chir,2006,85(8):416-418,420-422.
• [17]赵强,王宜青,夏利民,等.微创冠状动脉旁路术33例中期结果报告.中国微创外科杂志,2004,4(3):183-184.
• [18]肖连波,周岊梧,安淑芬,等.冠状动脉搭桥术中应用内窥镜采集大隐静脉118例临床分析.河北医药,2010,32(10):1277-1278.