CAJ | 학술논문

目的总结应用内窥镜采集静脉(endoscopic vein harvesting,EVH)技术获取大隐静脉(greater saphenous vein,GSV)进行冠状动脉旁路移植手术(coronary artery bypass grafting,CABG)后1年随访结果,评估采用EVH技术的手术效果.方法 2009年5月至2010年5月,136例患者应用EVH取GSV进行的非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG),112例开放静脉获取术(open vein harvesting,OVH)取GSV进行的OPCABG.评估71例应用EVH和64例传统手术切口取GSV行OPCABG患者1年随访结果,比较两组患者手术情况、下肢切口并发症、1年后移植血管通畅率以及心理状况.结果 EVH组与OVH组比较,在创面大小、伤口恢复及美观化、伤口感染率、神经功能影响、二次清创缝合率以及下肢切口总体并发症发生率等方面具有明显优势.比较两组患者术后1年移植血管通畅率,EVH组动脉移植血管通畅率96.8％,静脉移植血管通畅率85.7％；OVH组动脉移植血管通畅率94.9％,静脉移植血管通畅率86.4％.两组随访结果中心绞痛再发率、动脉移植通畅率、静脉移植通畅率差异均无统计学意义.EVH组患者心理状况调查结果优于OVH组.结论与常规OVH方法相比较,EVH技术对获取移植静脉具有更多优势,通过在采集前对患者进行部分肝素化等更具保护移植静脉材料的方法,EVH组也保持了满意的移植血管1年期通畅率.
목적 총결응용내규경채집정맥(endoscopic vein harvesting,EVH)기술획취대은정맥(greater saphenous vein,GSV)진행관상동맥방로이식수술(coronary artery bypass grafting,CABG)후1년수방결과,평고채용EVH기술적수술효과.방법 2009년5월지2010년5월,136례환자응용EVH취GSV진행적비체외순배관상동맥방로이식술(off-pump coronary artery bypass grafting,OPCABG),112례개방정맥획취술(open vein harvesting,OVH)취GSV진행적OPCABG.평고71례응용EVH화64례전통수술절구취GSV행OPCABG환자1년수방결과,비교량조환자수술정황、하지절구병발증、1년후이식혈관통창솔이급심리상황.결과 EVH조여OVH조비교,재창면대소、상구회복급미관화、상구감염솔、신경공능영향、이차청창봉합솔이급하지절구총체병발증발생솔등방면구유명현우세.비교량조환자술후1년이식혈관통창솔,EVH조동맥이식혈관통창솔96.8％,정맥이식혈관통창솔85.7％；OVH조동맥이식혈관통창솔94.9％,정맥이식혈관통창솔86.4％.량조수방결과중심교통재발솔、동맥이식통창솔、정맥이식통창솔차이균무통계학의의.EVH조환자심리상황조사결과우우OVH조.결론 여상규OVH방법상비교,EVH기술대획취이식정맥구유경다우세,통과재채집전대환자진행부분간소화등경구보호이식정맥재료적방법,EVH조야보지료만의적이식혈관1년기통창솔.
Objective To summarize the one-year follow-up clinical result of patients undergoing Endoscopic vein harvest (EVH) technology to collect greater saphenous vein( GSV )in coronary artery bypass operation (CABG),and to assess the related factors influencing the outcome.Methods 248 patients underwent off-pump coronary artery bypass grafting (OPCAG) from May 2009 to May 2010.Among these patients,136 patients with coronary artery disease received EVH technology to gain GSV,and 112 patients received conventional open vein harvesting (OVH).Then 71 EVH (group 1 ) patients and 64 OVH ( group 2 ) patients had one-year follow-up analysis.We compared and evaluated the data of two groups about operation information,lower limb wound complication,bridge blood vessels patency rate,and psychologic status.Results The date of wound surface size,wound healing and appearance,wound infection rate,the second debridement rate and the overall lower limb wound complication rate show that EVH was better than OVH.After one-year follow-up,we contrasted the patency rate of bridge blood vessels between two groups.The patency rate of arterial bridge blood vessels was 96.8％ ( venous bridge blood vessels was 85.7％ )in group of EVH when we followed up 63 patients;while the patency rate of arterial bridge blood vessels was 94.9％ ( venous bridge blood vessels was 86.4％ ) in group of OVH that we followed up 59 patients.We compared the outcome between two groups,and found that there were no statistical significance in angina recurrence rate,patency rate of venous graft and patency rate of arterial graft.But the psychologic status was different,the EVH group was better than OVH group.Conclusion Compared to OVH,EVH technique has more advantages.Through taking a more secure method in the collection process of the bridging vein material,EVH group also maintained a satisfactory one-year graft patency rate.