冠状动脉搭桥手术中采用内镜隐静脉采集术改善腿部伤口愈合：一项针对亚洲人群的前瞻性随机研究。

Improved leg wound healing with endoscopic saphenous vein harvest in coronary artery bypass graft surgery: a prospective randomized study in Asian population.

作者信息

Au Wing Kuk Tim, Chiu Shiu Wah, Sun Man Ping, Lam Kwok Tai, Lin Ming Fai, Chui Wing Hung, Yeung Chung Lai, Cheng Lik Cheung

机构信息

Department of Surgery, Division of Cardiothoracic Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Grantham Hospital, Hong Kong SAR, China.

出版信息

J Card Surg. 2008 Nov-Dec;23(6):633-7. doi: 10.1111/j.1540-8191.2008.00659.x.

DOI:10.1111/j.1540-8191.2008.00659.x

PMID:19016987

Abstract

OBJECTIVE

Conventional open saphenous vein harvest (OVH) for coronary artery bypass graft surgery is often associated with significant pain and morbidity. This study aims to determine whether endoscopic saphenous vein harvest (EVH) reduces leg wound morbidity and improves patient satisfaction as compared to OVH in Asian population.

METHODS

Between March 2005 and June 2006, 120 patients who underwent isolated CABG were prospectively randomized into EVH (n = 60) and OVH (n = 60) groups. VirtuoSaph (Terumo Cardiovascular Corp., Ann Arbor, MI, USA) harvesting system was used for EVH. We analyzed leg wound complications (ASEPSIS score), postoperative pain, satisfaction, and clinical outcomes. Fisher's exact test and Mann-Whitney U test were used for categorical and continuous variables analysis respectively.

RESULTS

Six patients in the EVH group required conversion to open technique. Both groups had matched demographic characteristics and risk factors. Mean numbers of grafts performed were 3.2 +/- 0.6 (EVH n = 54) and 3.0 +/- 0.7 (OVH n = 60) (p = 0.03). ASEPSIS scores at postoperation days three, seven, and 21 were significantly lower in the EVH group than the OVH group (p = 0.02, p = 0.002 and p = 0.01, respectively). Wound pain scores at postoperative days three, seven, and 21 were significantly lower in the EVH group (p = 0.000, p = 0.001 and p = 0.000 respectively). Wound numbness was found in 5.7% of the EVH group and 33.3% of the OVH group patients (p = 0.01). [Six patients required conversion to open technique.] There was one hospital mortality (OVH group) and major postoperative complications were not significantly different between the groups.

CONCLUSION

EVH system is a safe and effective alternative to OVH with better wound healing, reduced postoperative pain, and wound numbness. However, the higher conversion rate to OVH in Asian patients requires further evaluation.

摘要

目的

冠状动脉旁路移植手术中传统的开放式大隐静脉采集（OVH）常伴有明显疼痛和并发症。本研究旨在确定与OVH相比，内镜下大隐静脉采集（EVH）在亚洲人群中是否能降低腿部伤口并发症发生率并提高患者满意度。

方法

2005年3月至2006年6月期间，120例行单纯冠状动脉旁路移植术（CABG）的患者被前瞻性随机分为EVH组（n = 60）和OVH组（n = 60）。EVH采用VirtuoSaph（美国密歇根州安阿伯市泰尔茂心血管公司）采集系统。我们分析了腿部伤口并发症（ASEPSIS评分）、术后疼痛、满意度及临床结局。分别采用Fisher精确检验和Mann-Whitney U检验对分类变量和连续变量进行分析。

结果

EVH组有6例患者需转为开放技术。两组的人口统计学特征和危险因素相匹配。平均移植血管数量分别为3.2±0.6（EVH组，n = 54）和3.0±0.7（OVH组，n = 60）（p = 0.03）。术后第3天、第7天和第21天，EVH组的ASEPSIS评分显著低于OVH组（分别为p = 0.02、p = 0.002和p = 0.01）。术后第3天、第7天和第21天，EVH组的伤口疼痛评分显著更低（分别为p = 0.000、p = 0.001和p = 0.000）。EVH组5.7%的患者和OVH组33.3%的患者出现伤口麻木（p = 0.01）。[6例患者需转为开放技术。]有1例医院死亡（OVH组），两组术后主要并发症无显著差异。