Stavridis G T, Bobos D, Matsouka F, Lacoumenta S, Alivizatos P A
First Department of Cardiac Surgery and Transplantation, Department of Anaesthetics, The Onassis Cardiac Surgery Centre, Athens, Greece.
Heart Surg Forum. 1998;1(1):37-40.
Traditional open incisions for long saphenous vein (LSV) harvesting are common sources of post operative complications after coronary artery bypass grafting (CABG). To reduce pain and wound healing complications, minimally invasive harvesting techniques are being developed. We have investigated the use of a conventional laryngoscope for cost effective saphenous removal using short incisions and long subcutaneous tunnels.
The LSV was exposed through small incisions connected by long subcutaneous tunnels. Soft tissue retraction, visualization and illumination were provided by a sterilized laryngoscope with a #3 or #4 Macintosh blade. Dissection was performed with standard instruments while branch ligation was performed with vascular clips. Thirty two patients undergoing CABG between October 1997 and January 1998 underwent minimally invasive vein harvesting assisted by a laryngoscope. Clinical outcomes were evaluated.
There were 27 males and 5 females with a mean age of 62.6 +/- 9.3 years in this study. Adequate saphenous vein was removed in 29 of 32 cases. (In three patients, the vein was so superficial that an open incision proved easier). The length of harvested conduit averaged 38.2 +/- 11.01 centimeters (21-55 centimeters). Harvesting time average 37.1 minutes (+/-10.8 minutes; range from 20 to 62 minutes). Postoperatively, There were no wound dehiscences, infections, cellulitis, or major hematomas. Pain and leg edema were considerably less than with traditional open harvest.
Minimally invasive vein harvesting is less traumatic to the extremity with fewer complications and superior patient satisfaction. Although commercial disposable systems are now available to permit minimally invasive harvesting of the saphenous vein, a conventional laryngoscope can be used with much reduced costs.
传统的大隐静脉（LSV）采集开放切口是冠状动脉旁路移植术（CABG）术后并发症的常见来源。为了减少疼痛和伤口愈合并发症，正在开发微创采集技术。我们研究了使用传统喉镜通过短切口和长皮下隧道进行经济有效的大隐静脉切除术。
通过由长皮下隧道连接的小切口暴露大隐静脉。使用带有#3或#4麦金托什刀片的消毒喉镜进行软组织牵开、可视化和照明。用标准器械进行解剖，用血管夹进行分支结扎。1997年10月至1998年1月期间接受CABG的32例患者在喉镜辅助下进行了微创静脉采集。评估临床结果。
本研究中有27名男性和5名女性，平均年龄为62.6±9.3岁。32例患者中有29例成功采集到足够的大隐静脉。（在3例患者中，静脉非常表浅，开放切口证明更容易）。采集的管道平均长度为38.2±11.01厘米（21 - 55厘米）。采集时间平均为37.1分钟（±10.8分钟；范围为20至62分钟）。术后，没有伤口裂开、感染、蜂窝织炎或重大血肿。疼痛和腿部水肿明显少于传统开放采集。
微创静脉采集对肢体的创伤较小，并发症较少，患者满意度较高。虽然现在有商业一次性系统可用于微创采集大隐静脉，但传统喉镜可以以大大降低的成本使用。
