Wang Shaohua, Tang Hao, Wilkinson Vikki, Lukat Trish, Gelfand Elliot T, Koshal Arvind, Modry Dennis L, Mullen John C, Hao Chunhai, Finegan Barry A
Division of Cardiac Surgery, University of Alberta Hospitals, Edmonton, Alberta, Canada.
Ann Thorac Surg. 2005 Jun;79(6):2018-23. doi: 10.1016/j.athoracsur.2004.12.024.
Minimally invasive saphenous vein harvest (MIVH) techniques have been evaluated and reported with heterogeneous results. The aim of this study was to evaluate the efficacy of MIVH on the outcomes of postoperative leg wound healing and pain using the SaphLITE retractor system.
Two hundred twenty-five patients undergoing elective coronary artery bypass grafting surgery were randomized to receive either SaphLITE vein harvest (SVH) or conventional open vein harvest (OVH).
There were no significant differences between the two groups in demographics, postoperative mortalities and major complications. For SVH group and OVH group, total leg wound length was 18.33 +/- 7.93 cm vs 46.10 +/- 15.63 cm (p < 0.001), and vein harvest time was 50.70 +/- 16.55 minutes vs 40.35 +/- 16.43 minutes (p < 0.001). In-hospital leg wound healing disturbance (LWHD) rate was 4.7% for SVH group and 1.7% for OVH group (p = 0.190). Delayed LWHD rate was 16.0% for SVH group and 39.5% for OVH group (p < 0.001). Combined, LWHD rate was 20.8% for SVH group and 41.2% for OVH group (p = 0.001). There was no significant difference in the worst postoperative leg wound pain or length of hospital stay between the 2 groups. Double-blinded histologic examinations revealed normal vascular structure in the harvested veins from both groups.
Our study demonstrated that harvesting saphenous vein with SaphLITE retractor system is a good technique which is associated with reduced rate of delayed LWHD, preserved venous structural integrity, and acceptable harvest speed.
微创大隐静脉获取(MIVH)技术已得到评估并报道,但结果各异。本研究旨在使用SaphLITE牵开器系统评估MIVH对术后腿部伤口愈合和疼痛结局的疗效。
225例行择期冠状动脉旁路移植术的患者被随机分为接受SaphLITE静脉获取(SVH)或传统开放静脉获取(OVH)。
两组在人口统计学、术后死亡率和主要并发症方面无显著差异。SVH组和OVH组的总腿部伤口长度分别为18.33±7.93 cm和46.10±15.63 cm(p<0.001),静脉获取时间分别为50.70±16.55分钟和40.35±16.43分钟(p<0.001)。SVH组的院内腿部伤口愈合障碍(LWHD)率为4.7%,OVH组为1.7%(p=0.190)。SVH组的延迟LWHD率为16.0%,OVH组为39.5%(p<0.001)。综合来看,SVH组的LWHD率为20.8%,OVH组为41.2%(p=0.001)。两组术后最严重的腿部伤口疼痛或住院时间无显著差异。双盲组织学检查显示两组获取的静脉血管结构正常。
我们的研究表明,使用SaphLITE牵开器系统获取大隐静脉是一种良好的技术,与延迟LWHD率降低、保留静脉结构完整性及可接受的获取速度相关。