Felisky Chance D, Paull Daniel L, Hill Mark E, Hall R Alan, Ditkoff Mary, Campbell William G, Guyton Steven W
Department of Surgery, Section of Cardiothoracic Surgery, Virginia Mason Medical Center, 1201 Terry Ave., Seattle, WA 98101, USA.
Am J Surg. 2002 May;183(5):576-9. doi: 10.1016/s0002-9610(02)00835-8.
Most coronary artery bypass grafting (CABG) operations still involve the use of greater saphenous vein (GSV) for one or more grafts, even with the increasing use of arterial conduits for coronary revascularization. Wound complications from GSV harvesting are common, and sometimes severe. In order to reduce the morbidity of this procedure, we adopted a technique of endoscopic vein harvesting (EVH). EVH allows nearly complete harvest of the GSV, with excellent visualization, through minimal incisions. At our institution, a physician's assistant routinely performs EVH, usually while a cardiothoracic surgeon harvests an arterial conduit. In 1997, all GSV harvesting was performed by open technique. During a transition period in 1998 and 1999 we used several different endoscopic techniques. By the beginning of 2000, our technique of EVH was standardized and used routinely.
To determine whether EVH reduced the morbidity associated with conventional open vein harvesting (OVH), we reviewed the charts of all patients having primary coronary artery bypass operations utilizing GSV during the years 1997 and 2000.
The two groups were comparable in risk factors for leg incision complications. The year 2000 EVH group had a marked reduction in the number of wound complications compared with the year 1997 OVH group (7.1% versus 26.1%, P < 0.00001). There were no significant differences between the two groups in total operative time (OVH 224 minutes, EVH 223 minutes, number of distal coronary anastomoses (OVH 3.38 +/- 0.90, EVH 3.38 +/- 0.94), or the rate of clinically apparent early graft failure. There was a significant increase in the use of sequential grafting techniques in the 2000 group (OVH 21.9%, EVH 43.6%, P < 0.00001).
EVH reduced the morbidity associated with GSV harvesting. EVH was associated with an increased use of sequential coronary grafting techniques. EVH does not prolong operative time when performed by experienced personnel. We believe EVH should become the standard of care.
即使冠状动脉搭桥术（CABG）中动脉血管用于冠状动脉血运重建的情况日益增多，但大多数此类手术仍需使用大隐静脉（GSV）进行一个或多个移植。GSV采集引起的伤口并发症很常见，有时还很严重。为降低该手术的发病率，我们采用了内镜下静脉采集（EVH）技术。EVH通过微小切口，在极佳的视野下几乎能完整采集GSV。在我们机构，医师助理常规进行EVH操作，通常在心胸外科医生采集动脉血管时同步进行。1997年，所有GSV采集均采用开放技术。在1998年和1999年的过渡期间，我们使用了几种不同的内镜技术。到2000年初，我们的EVH技术标准化并常规使用。
为确定EVH是否降低了与传统开放静脉采集（OVH）相关的发病率，我们回顾了1997年和2000年期间所有使用GSV进行初次冠状动脉搭桥手术患者的病历。
两组在腿部切口并发症的危险因素方面具有可比性。2000年EVH组与1997年OVH组相比，伤口并发症数量显著减少（7.1%对26.1%，P < 0.00001）。两组在总手术时间（OVH 224分钟，EVH 223分钟）、冠状动脉远端吻合数量（OVH 3.38 +/- 0.90，EVH 3.38 +/- 0.94）或临床明显的早期移植失败率方面无显著差异。2000年组序贯移植技术的使用显著增加（OVH 21.9%，EVH 43.6%，P < 0.00001）。
EVH降低了与GSV采集相关的发病率。EVH与序贯冠状动脉移植技术的使用增加有关。由经验丰富的人员进行EVH时不会延长手术时间。我们认为EVH应成为护理标准。
