疑难病杂志
疑難病雜誌
의난병잡지
JOURNAL OF DIFFICULT AND COMPLICATED CASES
2014年
6期
551-554
,共4页
李波%顾承雄%李海涛%杨俊峰%韦华%李京倖%刘锐%黄信生%宋伟%李晖%李琴
李波%顧承雄%李海濤%楊俊峰%韋華%李京倖%劉銳%黃信生%宋偉%李暉%李琴
리파%고승웅%리해도%양준봉%위화%리경행%류예%황신생%송위%리휘%리금
内窥镜下血管采集%冠状动脉旁路移植术%大隐静脉%序贯吻合%近期疗效
內窺鏡下血管採集%冠狀動脈徬路移植術%大隱靜脈%序貫吻閤%近期療效
내규경하혈관채집%관상동맥방로이식술%대은정맥%서관문합%근기료효
Endoscopic vein harvesting%Coronary artery bypass grafting%Saphenous vein%Sequential graft%Short-term effects
目的：评价内窥镜下采集大隐静脉作为序贯桥血管的近期临床效果。方法回顾性分析应用静脉序贯桥行非体外循环冠状动脉旁路移植手术（ OPCAB）并完成随访的241例患者的临床资料，根据大隐静脉取材方式将患者分为内窥镜静脉采集（ EVH）组85例和开放静脉采集（ OVH）组156例，比较2组术后1年时下肢水肿范围、患者满意程度评分、临床预后（死亡、新发心肌梗死、再血管化）、桥血管通畅率。结果2组性别、年龄、左室射血分数（LVEF）、左室舒张末期内径（LVEDD）、陈旧心肌梗死、高血压、左主干病变等比较差异无统计学意义（ P ＞0^．05），而EVH组体质量指数、糖尿病比例高于OVH组，差异有统计学意义（ P ＜0．05）。与OVH组比较，EVH组序贯桥血管支数、序贯桥主干流量、主干搏动指数、每支桥血管流量和每支桥搏动指数等差异无统计学意义（ P ＞0．05）。 EVH组手术下肢水肿比例和程度均降低、患者满意度提高（ P ＜0．05）。2组术后1年新发心肌梗死、再血管化及桥血管通畅率差异无统计学意义（ P ＞0．05）。结论 CABG术中采取EVH采集小腿大隐静脉作为序贯桥血管能有效降低下肢水肿，提高患者满意度，但并不影响序贯静脉桥1年通畅率。
目的：評價內窺鏡下採集大隱靜脈作為序貫橋血管的近期臨床效果。方法迴顧性分析應用靜脈序貫橋行非體外循環冠狀動脈徬路移植手術（ OPCAB）併完成隨訪的241例患者的臨床資料，根據大隱靜脈取材方式將患者分為內窺鏡靜脈採集（ EVH）組85例和開放靜脈採集（ OVH）組156例，比較2組術後1年時下肢水腫範圍、患者滿意程度評分、臨床預後（死亡、新髮心肌梗死、再血管化）、橋血管通暢率。結果2組性彆、年齡、左室射血分數（LVEF）、左室舒張末期內徑（LVEDD）、陳舊心肌梗死、高血壓、左主榦病變等比較差異無統計學意義（ P ＞0^．05），而EVH組體質量指數、糖尿病比例高于OVH組，差異有統計學意義（ P ＜0．05）。與OVH組比較，EVH組序貫橋血管支數、序貫橋主榦流量、主榦搏動指數、每支橋血管流量和每支橋搏動指數等差異無統計學意義（ P ＞0．05）。 EVH組手術下肢水腫比例和程度均降低、患者滿意度提高（ P ＜0．05）。2組術後1年新髮心肌梗死、再血管化及橋血管通暢率差異無統計學意義（ P ＞0．05）。結論 CABG術中採取EVH採集小腿大隱靜脈作為序貫橋血管能有效降低下肢水腫，提高患者滿意度，但併不影響序貫靜脈橋1年通暢率。
목적：평개내규경하채집대은정맥작위서관교혈관적근기림상효과。방법회고성분석응용정맥서관교행비체외순배관상동맥방로이식수술（ OPCAB）병완성수방적241례환자적림상자료，근거대은정맥취재방식장환자분위내규경정맥채집（ EVH）조85례화개방정맥채집（ OVH）조156례，비교2조술후1년시하지수종범위、환자만의정도평분、림상예후（사망、신발심기경사、재혈관화）、교혈관통창솔。결과2조성별、년령、좌실사혈분수（LVEF）、좌실서장말기내경（LVEDD）、진구심기경사、고혈압、좌주간병변등비교차이무통계학의의（ P ＞0^．05），이EVH조체질량지수、당뇨병비례고우OVH조，차이유통계학의의（ P ＜0．05）。여OVH조비교，EVH조서관교혈관지수、서관교주간류량、주간박동지수、매지교혈관류량화매지교박동지수등차이무통계학의의（ P ＞0．05）。 EVH조수술하지수종비례화정도균강저、환자만의도제고（ P ＜0．05）。2조술후1년신발심기경사、재혈관화급교혈관통창솔차이무통계학의의（ P ＞0．05）。결론 CABG술중채취EVH채집소퇴대은정맥작위서관교혈관능유효강저하지수종，제고환자만의도，단병불영향서관정맥교1년통창솔。
Objective To evaluate the short term clinical effects of sequential saphenous vein graft harvested by en -doscopy.Methods Retrospectively analyzed 241 patients who received off pump coronary artery bypass grafting and finished the one year follow up with sequential saphenous vein graft from Aug 2011 to Nov 2012 .Based on vein harvesting methods , the patients were divided into endoscopic vein harvesting group (EVH) and open vein harvesting group (OVH).The com-pared items included edema area in the lower limbs , patients'satisfaction score , clinical outcomes ( myocardial infarction and revascularization ) and graft patency .Results There were no significant differences of 2 groups of gender , age, LVEF, LVEDD, old myocardial infarction, hypertension, left main disease ( P >0.05), while in EVH group, body mass index, di-abetes is higher than the OVH group , the difference was statistically significant ( P <0.05). Compared with OVH group, there were no significant sequential grafts count , sequential bridge , main trunk flow pulsatility index, blood flow of each bridge and a bridge pulsate index with EVH group ( P >0.05).In EVH group, the satisfaction of operation were improve and lower extremity edema ratio decreased ( P <0.05).After 1 years, new myocardial infarction, revascularization and the patency rates did not show statistically significant among the 2 groups ( P >0.05).Conclu sion Sequential saphenous vein graft har-vested via EVH during off pump CABG can effectively reduce lower limb edema and improve patient 's satisfaction without af-fecting graft patency one year after the surgery .
