内镜下桡动脉获取术优于开放技术。

Endoscopic radial artery harvesting is better than the open technique.

作者信息

Patel Amit N, Henry A Carl, Hunnicutt Carol, Cockerham Carol Ann, Willey Brittany, Urschel Harold C

机构信息

Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Texas 75246, USA.

出版信息

Ann Thorac Surg. 2004 Jul;78(1):149-53; discussion 149-53. doi: 10.1016/j.athoracsur.2004.03.001.

DOI:10.1016/j.athoracsur.2004.03.001

PMID:15223420

Abstract

BACKGROUND

Radial arteries are being used more often for coronary artery bypass grafting. A minimally invasive technique was devised for harvesting vessels and compared with the traditional harvesting technique.

METHODS

In a prospective study of 200 consecutive patients undergoing coronary artery bypass grafting, 100 patients had traditional open radial artery harvesting and 100 underwent endoscopic radial artery harvesting. All patients had a preoperative modified Allen's test with Doppler imaging. The traditional technique involved a longitudinal incision over the radial aspect of the arm from the wrist to the antecubital fossa. The radial artery was dissected subfascially and removed. The endoscopic technique involved a 3-cm incision over the radial aspect of the arm. A vessel loop was placed around the artery and carbon dioxide was insufflated into the wound. The radial artery was dissected to the brachial artery and ligated with an Endo-loop ligature. The branches were divided with bipolar electrocautery and ligated with clips. Patients were evaluated for postoperative pain, bleeding, neuralgias, infection, and any adverse events. A p value of less than 0.05 was considered significant.

RESULTS

All 200 radial arteries were successfully harvested and used as grafts. Patients who had undergone endoscopic radial artery harvesting had significantly fewer major complications than patients who underwent the open technique: hematomas (five versus no complications) or wound infections requiring antibiotics (seven versus one complication). The occurrence of major neuralgias that restricted function were also significantly lower postoperatively and 1, 3, and 6 months later (ten versus one, eight versus one, five versus zero, and one versus zero, respectively).

CONCLUSIONS

Endoscopic radial artery harvesting results in good cosmetic results, useable grafts, and minimal neuralgias. Endoscopic radial artery harvesting is better than traditional open radial artery harvesting.

摘要

背景

桡动脉在冠状动脉旁路移植术中的应用越来越频繁。设计了一种微创技术来获取血管，并与传统获取技术进行比较。

方法

在一项对200例连续接受冠状动脉旁路移植术患者的前瞻性研究中，100例患者采用传统的开放桡动脉获取方法，100例患者接受内镜下桡动脉获取。所有患者术前均采用多普勒成像进行改良艾伦试验。传统技术包括在手臂桡侧从腕部到肘前窝做一纵向切口。在筋膜下解剖并取出桡动脉。内镜技术包括在手臂桡侧做一个3厘米的切口。在动脉周围放置血管环，并向伤口内注入二氧化碳。将桡动脉解剖至肱动脉，并用Endo-loop结扎线结扎。分支用双极电凝切断并用夹子结扎。对患者进行术后疼痛、出血、神经痛、感染及任何不良事件的评估。p值小于0.05被认为具有统计学意义。

结果

所有200条桡动脉均成功获取并用作移植物。接受内镜下桡动脉获取的患者比接受开放技术的患者发生的主要并发症明显更少：血肿（5例对无并发症）或需要使用抗生素的伤口感染（7例对1例并发症）。术后以及术后1、3和6个月时，限制功能的主要神经痛的发生率也显著更低（分别为10例对1例、8例对1例、5例对0例、1例对0例）。