Tennyson Charlene, Young Christopher P, Scarci Marco
King's College Medical School, London, UK.
Interact Cardiovasc Thorac Surg. 2010 Apr;10(4):625-9. doi: 10.1510/icvts.2009.227090. Epub 2010 Jan 25.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: in [patients undergoing coronary revascularisation] is [endoscopic vein harvest] superior to [open harvest] in improving [clinical outcome and cost effectiveness]? Altogether >166 papers were found using the reported search, of which eight represented the best evidence to answer the clinical question. All papers agree that endoscopic vein harvesting (EVH) reduces the level of postoperative pain (pain score for EVH=0.52+/-0.95; open technique=1.02+/-1.51; P=0.03) and wound complications (range from 3 to 7.4% for EVH and 13 to 19.4% for conventional technique). These clinical benefits were associated with a high level of patient satisfaction. On average, four papers found that the length of hospital stay was reduced in the EVH group [weighted mean difference (WMD) -1.04 to -0.85; confidence interval (CI) -1.92 to -0.16; P=0.02]. The overall occlusion rates of venous grafts after six months were 21.7% for EVH and 17.6% for open technique. There were no differences in the six months occlusion and disease rates between EVH and conventional vein harvest (CVH), as determined by means of univariate analysis (P=0.584). However, some papers (PREVENT-IV sub-analysis and Yun et al.) called into question EVH by reporting high vein occlusion rates. At six months, this was 21.7% for EVH and 17.6% for open technique rising to 46.7% vs. 38.0% (P<0.001) at 12-18 months. At three years, endoscopic harvesting was also associated with higher rates of death, myocardial infarction, or repeat revascularisation (20.2% vs. 17.4%; P=0.04), death or myocardial infarction (9.3% vs. 7.6%; P=0.01), and death (7.4% vs. 5.8%; P=0.005). We conclude that EVH reduces the level of postoperative pain and wound complication, with a high-level of patient satisfaction but a sub-analysis of a large RCT has recently called into question the medium- to long-term patency of grafts endoscopically harvested.
根据结构化方案撰写了一篇心脏外科的最佳证据主题文章。所探讨的问题是：在[接受冠状动脉血运重建的患者]中，[内镜下取静脉]在改善[临床结局和成本效益]方面是否优于[开放取静脉]？通过报告的检索共找到166篇以上论文，其中8篇代表回答该临床问题的最佳证据。所有论文均认为，内镜下取静脉（EVH）可降低术后疼痛程度（EVH的疼痛评分为0.52±0.95；开放技术为1.02±1.51；P=0.03）和伤口并发症（EVH为3%至7.4%，传统技术为13%至19.4%）。这些临床益处伴随着较高的患者满意度。平均而言，4篇论文发现EVH组的住院时间缩短[加权平均差（WMD）-1.04至-0.85；置信区间（CI）-1.92至-0.16；P=0.02]。6个月后静脉移植物的总体闭塞率，EVH为21.7%，开放技术为17.6%。通过单因素分析确定，EVH与传统静脉取栓（CVH）在6个月的闭塞率和疾病发生率方面无差异（P=0.584）。然而，一些论文（PREVENT-IV亚分析和Yun等人）通过报告高静脉闭塞率对EVH提出质疑。在6个月时，EVH为21.7%，开放技术为17.6%；在12至18个月时分别升至46.7%和38.0%（P<0.001）。在3年时，内镜取栓还与更高的死亡、心肌梗死或再次血运重建率相关（20.2%对17.4%；P=0.04），死亡或心肌梗死（9.3%对7.6%；P=0.01），以及死亡率（7.4%对5.8%；P=0.005）。我们得出结论，EVH可降低术后疼痛程度和伤口并发症，患者满意度较高，但最近一项大型随机对照试验的亚分析对内镜下获取的移植物的中长期通畅性提出了质疑。
