[用于冠状动脉搭桥术的内镜下静脉移植物获取：对手术部位感染高危患者效果良好]

[Endoscopic vein-graft harvesting for coronary bypass grafting: good results in patients at risk for surgical site infection].

作者信息

Ikram Muhammad U Z, Li Wilson W L, Segers Patrique, Kloek Jaap J, de Mol Bas A

机构信息

Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Cardiothoracale chirurgie, Amsterdam, the Netherlands.

出版信息

Ned Tijdschr Geneeskd. 2010;154:A1806.

PMID:20858296

Abstract

OBJECTIVE

To determine the clinical impact of endoscopic vein-graft harvesting in patients undergoing coronary artery bypass grafting (CABG) who are at risk for surgical site infection.

DESIGN

Retrospective cohort study.

METHOD

Of patients undergoing elective CABG between March 1st 2006 and March 1st 2007, 335 were eligible for analysis. The results of endoscopic vein-graft harvesting were compared with traditional open vein-graft harvesting. Medical records of all patients were reviewed and data collection was completed by means of a telephone survey. The primary outcome measure was the incidence of surgical site infections. Secondary outcome measures were duration of hospital stay, patient satisfaction and quality of life.

RESULTS

Among the 335 patients included the incidence of surgical site infection was 2.5% following open harvesting (n = 236) and 2.0% following endoscopic harvesting (n = 99; p = 0.08). Patients in the endoscopic harvesting group had more risk factors for surgical site infection (diabetes, peripheral artery disease, obesity). Surgical site infection after open harvesting resulted in a prolonged hospital stay and a higher number of patients undergoing open wound treatment, re-admittance and additional surgical procedures. Total mean hospital stay in the open harvesting group was 7.9 days and 6.1 days in the endoscopic harvesting group (p < 0.05). Patients were more satisfied with the surgical wound after endoscopic harvesting compared with open harvesting (patient satisfaction score: 8.6 versus 7.8; p < 0.001).

CONCLUSION

Endoscopic vein-graft harvesting resulted in a - statistically non-significant - lower incidence of surgical site infection than open harvesting, although the patients had a higher risk for infections. Infections in the endoscopic harvesting group were less severe. The hospital stay was shorter and the patient satisfaction was higher than in the open harvesting group.

摘要

目的

确定在有手术部位感染风险的冠状动脉旁路移植术（CABG）患者中，内镜下静脉移植物获取的临床影响。

设计

回顾性队列研究。

方法

在2006年3月1日至2007年3月1日期间接受择期CABG的患者中，335例符合分析条件。将内镜下静脉移植物获取的结果与传统开放静脉移植物获取的结果进行比较。对所有患者的病历进行了回顾，并通过电话调查完成了数据收集。主要结局指标是手术部位感染的发生率。次要结局指标是住院时间、患者满意度和生活质量。

结果

在纳入的335例患者中，开放获取后手术部位感染的发生率为2.5%（n = 236），内镜获取后为2.0%（n = 99；p = 0.08）。内镜获取组的患者有更多手术部位感染的危险因素（糖尿病、外周动脉疾病、肥胖）。开放获取后手术部位感染导致住院时间延长，接受开放伤口治疗、再次入院和额外手术的患者数量增加。开放获取组的总平均住院时间为7.9天，内镜获取组为6.1天（p < 0.05）。与开放获取相比，患者在内镜获取后对手术伤口更满意（患者满意度评分：8.6对7.8；p < 0.001）。