内镜下与传统大隐静脉获取术后腿部伤口并发症的危险因素。

Risk factors for leg wound complications following endoscopic versus traditional saphenous vein harvesting.

作者信息

Allen K B, Heimansohn D A, Robison R J, Schier J J, Griffith G L, Fitzgerald E B, Isch J H, Abraham S, Shaar C J

机构信息

Indiana Heart Institute, St. Vincent Hospital and Health Care Center, Indianapolis, USA.

出版信息

Heart Surg Forum. 2000;3(4):325-30.

PMID:11178296

Abstract

BACKGROUND

Risk factors for leg wound complications following traditional saphenectomy have included: obesity, diabetes, female gender, anemia, age, and peripheral vascular disease. Use of an endoscopic saphenectomy technique may modify the risk factor profile associated with a traditional longitudinal incision.

METHODS

From September 1996 to May 1999, 276 consecutive patients who underwent elective isolated coronary artery bypass grafting performed by a single surgeon (K.B.A.) had their greater saphenous vein harvested endoscopically. During the period from January 1999 to May 1999, the surgical records of 643 patients who underwent the same operation and had a traditional longitudinal saphenectomy were reviewed for postoperative leg wound complications. Group demographics were similar regarding preoperative risk stratification and traditionally identified wound complication risk factors (diabetes, gender, obesity, preoperative anemia, and peripheral vascular disease). Leg wound complications were defined as: hematoma, dehiscence, cellulitis, necrosis, or abscess requiring dressing changes, antibiotics and/or debridement prior to complete epithelialization. Follow-up was 100% at six weeks.

RESULTS

Leg wound complications following endoscopic harvest occurred in 3% (9/276) of patients versus 17% (110/643) of traditional harvest patients (p < 0.0001). No univariate risk factors for wound complications were associated with endoscopic saphenectomy. Univariate predictors of wound complications following traditional saphenectomy included: diabetes (p = 0.001), obesity (p = 0.0005), and female gender (p = 0.005). Multivariable risk factors for leg wound complications following saphenectomy were traditional harvest technique (OR 7.56, CI 3.8-17.2, p < 0.0001), diabetes (OR 2.10, CI 1.4-3.2, p = 0.0006) and obesity (OR 1.82, CI 1.2-2.8, p = 0.007).

CONCLUSIONS

Traditional longitudinal saphenectomy is a multivariable risk factor for development of leg wound complications. Endoscopic saphenectomy modifies the risk factor profile for wound complications and should be the standard of care, particularly for obese and/or diabetic patients who require venous conduit during coronary artery bypass grafting.

摘要

背景

传统大隐静脉剥脱术后腿部伤口并发症的危险因素包括：肥胖、糖尿病、女性、贫血、年龄和外周血管疾病。使用内镜下大隐静脉剥脱技术可能会改变与传统纵向切口相关的危险因素。

方法

1996年9月至1999年5月，由同一外科医生（K.B.A.）连续进行择期单纯冠状动脉旁路移植术的276例患者接受了内镜下大隐静脉采集。在1999年1月至1999年5月期间，回顾了643例接受相同手术并进行传统纵向大隐静脉剥脱术患者的手术记录，以了解术后腿部伤口并发症情况。两组在术前风险分层和传统确定的伤口并发症危险因素（糖尿病、性别、肥胖、术前贫血和外周血管疾病）方面的人口统计学特征相似。腿部伤口并发症定义为：血肿、裂开、蜂窝织炎、坏死或脓肿，在完全上皮化之前需要更换敷料、使用抗生素和/或清创。六周时随访率为100%。

结果

内镜采集后腿部伤口并发症发生率为3%（9/276），而传统采集患者为17%（110/643）（p<0.0001）。内镜下大隐静脉剥脱术与伤口并发症的单变量危险因素无关。传统大隐静脉剥脱术后伤口并发症的单变量预测因素包括：糖尿病（p=0.001）、肥胖（p=0.0005）和女性（p=0.005）。大隐静脉剥脱术后腿部伤口并发症的多变量危险因素为传统采集技术（OR 7.56，CI 3.8 - 17.2，p<0.0001）、糖尿病（OR 2.10，CI 1.4 - 3.2，p = 0.0006）和肥胖（OR 1.82，CI 1.2 - 2.8，p = 0.007）。