Illig K A, Rhodes J M, Sternbach Y, Shortell C K, Davies M G, Green R M
Division of Vascular Surgery, University of Rochester Medical Center, NY 14642, USA.
Ann Vasc Surg. 2001 Jan;15(1):104-9. doi: 10.1007/s100160010005.
To determine whether less-invasive saphenous vein harvest reduces morbidity in patients undergoing infrainguinal bypass, we retrospectively compared 61 patients undergoing endoscopic harvest (ENDO) with 49 patients undergoing conventional harvest (OPEN) over the past 13 months. Patients were classified as potential short-stay if adjunctive suprainguinal inflow procedures or foot amputations were not required and the patient was ambulatory prior to elective operation. Mean endoscopic harvest time was 50+/-18 (range 25-90) min, and no more than three 5-cm incisions were required in 87% of cases. Szilagyi class II or III wound complications occurred after 1 of the 61 (2%) ENDO procedures and 7 of the 49 (14%) OPEN (p < 0.01), and any complication occurred in 13 (21%) vs. 25 (51%) of ENDO and OPEN procedures, respectively (p < 0.002). Mean postoperative length of stay was significantly shorter in the 24 short-stay ENDO (4.0+/-2.4 days) vs. 25 short-stay OPEN (6.0+/-3.2 days) patients (p < 0.02). Thirty-day patency rates between the two groups were not different. Endoscopic saphenous vein harvest is associated with a reduced incidence of serious wound complications and, in selected patients, shortened postoperative hospital stay.
为了确定在接受腹股沟下旁路手术的患者中,采用创伤较小的大隐静脉获取方法是否能降低发病率,我们回顾性比较了过去13个月中61例行内镜下获取(ENDO)的患者和49例行传统获取(OPEN)的患者。如果不需要辅助性腹股沟上流入手术或足部截肢,且患者在择期手术前能够行走,则将患者分类为潜在的短期住院患者。内镜下获取的平均时间为50±18(范围25 - 90)分钟,87%的病例所需切口不超过三个5厘米。61例(2%)ENDO手术中有1例发生了西拉吉II级或III级伤口并发症,49例(14%)OPEN手术中有7例发生(p < 0.01),ENDO和OPEN手术中分别有13例(21%)和25例(51%)发生了任何并发症(p < 0.002)。24例短期住院的ENDO患者术后平均住院时间(4.0±2.4天)明显短于25例短期住院的OPEN患者(6.0±3.2天)(p < 0.02)。两组的30天通畅率没有差异。内镜下大隐静脉获取与严重伤口并发症的发生率降低相关,并且在选定的患者中,术后住院时间缩短。