摘要
目的评价冠状动脉旁路移植术中应用内窥镜采集大隐静脉的近期效果,总结其要点。方法回顾性分析2009年7月至2013年8月沈阳军区总医院冠状动脉旁路移植术中采用内窥镜采集大隐静脉554例患者的临床资料,其中男372例、女182例,年龄38~84（61.3±9.0）岁。分析临床效果、术后疼痛、下肢水肿、伤口感染及愈合等情况。结果应用内窥镜采集大隐静脉过程中,13例患者因皮下脂肪少,中途转换为皮肤桥技术或者部分开放切口。平均采集静脉数为1~4（2.0±0.6）支,静脉桥质量满意,术后下肢水肿和伤口疼痛明显减轻,无伤口愈合不良及伤口感染。全组住院期间死亡7例,2例为围术期心肌梗死,2例为肺部感染,1例为心室颤动,1例为大面积脑梗死,1例为多脏器功能衰竭。随访452例,随访120~1 460（742.6±188.5）d,随访期间无死亡及再次干预病例。结论内窥镜血管采集术是安全、有效的技术,可以减少下肢伤口疼痛和下肢水肿;与全程或间断切开皮肤等传统方法相比,能够获得相近的静脉质量,更快的恢复和美容效果。
Objective To investigate short-term outcomes and surgical techniques of endoscopic saphenous vein harvesting（ESVH） for coronary artery bypass grafting（CABG）. Methods Clinical data of 554 patients undergoing CABG with ESVH in General Hospital of Shenyang Military between July 2009 and August 2013 were retrospectively analyzed. There were 372 male and 182 female patients with their age of 38-84（61.3±9.0） years. Clinical outcomes, postoperative lower extremity pain and edema, wound infection and healing were analyzed. Results During ESVH, 13 patients with very little subcutaneous fat received transition to skin bridge technology or partially open incision. Average number of harvested vein grafts was 1-4（2.0±0.6）, and the quality of the vein grafts was satisfactory. Postoperative lower extremity pain and edema were significantly reduced, and there was no delayed wound healing or infection. Seven patients died postoperatively, including 2 patients with perioperative myocardial infarction, 2 patients with pneumonia, 1 patient with ventricular fibrillation, 1 patient with massive cerebral infarction, and 1 patient with multiple organ dysfunction syndrome. A total of 452 patients were followed up for 120-1 460（742.6±188.5） days. There was no late death or reintervention during follow-up. Conclusion ESVH is a safe and efficacious procedure with less postoperative lower extremity pain and edema, satisfactory vein graft quality, better postoperative recovery and cosmetic results, compared with traditional fully or intermittently open wound for saphenous vein harvesting.
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2015年第1期57-60,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
冠状动脉旁路移植术
内窥镜
大隐静脉
Coronary artery bypass grafting
Endoscopy
Great saphenous vein
