摘要
目的比较内窥镜技术与常规开放式获取大隐静脉在冠状动脉旁路移植术围术期的安全性和近期疗效,探讨内窥镜下获取大隐静脉在冠状动脉旁路移植术中的应用价值。方法冠状动脉旁路移植术患者202例,其中采用内窥镜获取大隐静脉者103例为内窥镜组,采用常规开放式获取大隐静脉者99例为对照组,比较2组手术时间、术毕静脉桥总干平均血流量和搏动指数、术中输血比率、术后呼吸机使用时间、围术期病死率、术后并发症发生情况、术后第1、2、3天肌酸激酶同工酶和高敏肌钙蛋白T水平、术后左室射血分数、术后住院时间,观察2组患者术后1周下肢切口愈合情况。结果内窥镜组术后下肢切口麻木、水肿和疼痛发生率(5.8%、6.8%、7.8%)低于对照组(22.2%、20.2%、25.3%)(P<0.05),内窥镜组糖尿病患者术后下肢切口麻木、水肿和疼痛发生率(2.9%、2.9%、5.9%)低于对照组糖尿病患者(25.6%、30.8%、30.8%)(P<0.05);内窥镜组术后第1、2、3天血清高敏肌钙蛋白T[194.90(122.10,314.50)、150.50(88.40,223.30)、115.10(67.00,174.30)ng/L]和肌酸激酶同工酶[5.16(3.45,9.52)、3.56(2.15,5.65)、1.87(1.11,2.78)μg/L]与对照组[164.40(92.00,248.40)、122.80(69.90,224.50)、87.64(36.70,152.50)ng/L,4.96(3.33,9.31)、3.50(2.53,4.63)、1.94(1.21,2.85)μg/L]比较差异无统计学意义(P>0.05),术后第1、2、3天,2组血清高敏肌钙蛋白T和肌酸激酶同工酶水平均依次降低(P<0.05),均高于术前(P<0.05);内窥镜组术毕静脉桥总干平均血流量[(69.41±39.25)mL/min]和搏动指数(1.91±0.71)与对照组[(78.58±35.74)mL/min、1.92±0.67]比较差异无统计学意义(P>0.05);2组手术时间、术中输血比率、术后呼吸机应用时间、术后左室射血分数、术后住院时间及围术期病死率、术后并发症发生率比较差异均无统计学意义(P>0.05)。结论内窥镜下获取大隐静脉在冠状动脉旁路移植术中有良好的围术期效果,与传统获取大隐静脉的方法相比,可减少下肢伤口麻木、疼痛和水肿发生率。
Objective To compare the perioperative safety and short-term efficacies of endoscopic technique versus conventional open method for harvesting great saphenous vein in coronary artery bypass grafting(CABG), and to explore the application value of endoscopic vein harvesting in CABG. Methods In 202 patients undergoing CABG, 103 patients underwent endoscopy to obtain the great saphenous vein(endoscopy group), and 99 patients underwent conventional open surgery to obtain the great saphenous vein(control group). The operation time, postoperative venous bridge blood flow volume, postoperative pulsatility index, percentage of intraoperative blood transfusion, postoperative ventilation time, perioperative fatality, postoperative complications, creatine kinase-MB and high-sensitivity cardiac troponin T levels on the first, second and third days after operation, postoperative left ventricular ejection fraction and postoperative hospital stay were compared between two groups.The healing of lower limb incision was observed one week after operation in two groups.Results The incidences of postoperative numbness,edema and pain of lower limb incision were lower in endoscopy group(5.8%,6.8%,7.8%)than those in control group(22.2%,20.2%,25.3%)(P<0.05),and higher in diabetic patients in endoscopy group(2.9%,2.9%,5.9%)than those in diabetic patients in control group(25.6%,30.8%,30.8%)(P<0.05).There were no significant differences in high-sensitivity cardiac troponin T levels(194.90(122.10,314.50),150.50(88.40,223.30),115.10(67.00,174.30)ng/L)and creatine kinase-MB levels(5.16(3.45,9.52),3.56(2.15,5.65),1.87(1.11,2.78)μg/L)on the first,second and third days after operation between endoscopic group and control group(164.40(92.00,248.40),122.80(69.90,224.50),87.64(36.70,152.50)ng/L;4.96(3.33,9.31),3.50(2.53,4.63),1.94(1.21,2.85)μg/L)(P>0.05).The levels of high-sensitivity cardiac troponin T and creatine kinase-MB decreased gradually in turn on the first,second and third days after operation,which were higher than those before operation(P<0.05).The vein bridge blood flow volume and pulsatility index showed no significant differences between endoscopy group((69.41±39.25)mL/min,1.91±0.71)and control group((78.58±35.74)mL/min,1.92±0.67)(P>0.05).There were no significant differences in the operation time,percentage of intraoperative blood transfusion,postoperative ventilation time,postoperative left ventricular ejection fraction,postoperative hospital stay,perioperative fatality and postoperative complications between two groups(P>0.05).Conclusion The great saphenous vein obtained by endoscopic technique has a good perioperative efficacy in CABG.Compared with conventional open surgery,endoscopic vein harvesting can significantly reduce lower limb incision numbness,pain and edema.
作者
马露
程兆云
侯剑峰
王圣
胡俊龙
张华坤
郑道阔
赵勇
刘前进
MA Lu;CHENG Zhao-yun;HOU Jian-feng;WANG Sheng;HU Jun-long;ZHANG Hua-kun;ZHENG Dao-kuo;ZHAO Yong;LIU Qian-jin(Department of Cardiovascular Surgery,Henan University People's Hospital,Henan Provincial People's Hospital,Zhengzhou,Henan 450003,China;Department of Cardiovascular Surgery,Heart Center of Henan Provincial People's Hospital,Central China Fuwai Hospital,Zhengzhou,Henan 451464,China;Department of Cardiovascular Surgery,Fuwai Hospital,Chinese Academy of Medical Sciences,National Center for Cardiovascular Diseases,Beijing 100037,China)
出处
《中华实用诊断与治疗杂志》
2021年第2期122-126,共5页
Journal of Chinese Practical Diagnosis and Therapy
基金
国家自然科学基金(31970766)
河南省医学科技攻关计划项目(2018020438)
河南省医学教育研究项目(Wjlx2020167)。
关键词
冠心病
冠状动脉旁路移植术
微创
内窥镜下获取大隐静脉
coronary heart disease
coronary artery bypass grafting
minimally invasive
endoscopic vein harvesting
