Markar Sheraz R, Kutty Ramesh, Edmonds Lyn, Sadat Umar, Nair Sukumaran
Department of Cardiothoracic Surgery, Papworth Hospital, Papworth Everard, Cambridge, UK.
Interact Cardiovasc Thorac Surg. 2010 Feb;10(2):266-70. doi: 10.1510/icvts.2009.222430. Epub 2009 Nov 26.
The long saphenous vein remains the most commonly used conduit in coronary artery bypass surgery. Vein harvest is a critical component of this operation with significant morbidity associated with large leg wounds from open techniques. Here, we analyse the available literature comparing minimally invasive techniques vs. the traditional open method for vein harvest. A systematic literature search of Medline, Embase and Cochrane databases was performed using the following terms; 'saphenous vein', 'coronary artery bypass', 'tissue and organ harvesting' and 'endoscopic'. Relevant papers were then analysed using Statsdirect software. There was significantly reduced leg wound infection, leg wound haematoma and postoperative pain in the minimally invasive group. There was no statistical difference between the groups for vein harvest time, length of hospital stay and incidence of vein injury. There was a significantly reduced long-term graft patency in veins harvested by a minimally invasive technique. The results of this meta-analysis demonstrate the operative advantages of minimally invasive techniques for the purposes of vein harvest in coronary artery bypass surgery. However, further studies are required to look at long-term graft patency following minimally invasive vein harvest as this remains a major concern.
大隐静脉仍是冠状动脉搭桥手术中最常用的血管移植物。静脉获取是该手术的关键环节，开放技术导致的大腿大伤口会引发显著的并发症。在此，我们分析了比较微创技术与传统开放方法获取静脉的现有文献。使用以下检索词对Medline、Embase和Cochrane数据库进行了系统的文献检索：“大隐静脉”“冠状动脉搭桥”“组织和器官获取”以及“内镜检查”。然后使用Statsdirect软件对相关论文进行分析。微创组的腿部伤口感染、腿部伤口血肿和术后疼痛明显减少。两组在静脉获取时间、住院时间和静脉损伤发生率方面无统计学差异。微创技术获取的静脉长期通畅率显著降低。该荟萃分析的结果表明，在冠状动脉搭桥手术中，微创技术在静脉获取方面具有手术优势。然而，由于长期通畅率仍是一个主要问题，因此需要进一步研究观察微创静脉获取后的长期通畅情况。
