Department of Cardiothoracic Surgery, University Hospital Maastricht, P.Debyelaan 25, 6229 HX Maastricht, The Netherlands.
Cardiol Res Pract. 2011 Mar 20;2011:813512. doi: 10.4061/2011/813512.
Conventional open harvest of the great saphenous vein (GSV) during CABG results in approximately 7% donor-site complications. Using endoscopic vein harvesting (EVH) the full GSV length can be harvested through a 3 cm incision. This nonsystematic review discusses several key issues concerning EVH, based on an extensive Pubmed search. Found studies show that EVH results in reduced number of wound complications, less postoperative pain, earlier postoperative mobilisation, reduced length of hospital stay, and is more cost-effective. Initial studies did not find significant differences in graft histology, patency, or clinical outcome. However, in 2009 convincing evidence of inferior histological graft properties became available. Furthermore, an observational study showed that EVH resulted in significantly more graft stenosis, was associated with higher mortality, more myocard infarction, and more reinterventions. Most recent publications could not confirm these findings, however larger randomised controlled trials focusing on graft quality are being awaited.
在 CABG 中，传统的大隐静脉（GSV）开放性收获会导致约 7%的供体部位并发症。使用内镜静脉采集（EVH），可以通过 3cm 的切口采集完整的 GSV 长度。本非系统性综述基于广泛的 Pubmed 搜索，讨论了 EVH 的几个关键问题。已发现的研究表明，EVH 可减少伤口并发症的发生，减轻术后疼痛，更早地进行术后活动，缩短住院时间，并且更具成本效益。最初的研究并未发现移植物组织学、通畅性或临床结果有显著差异。然而，2009 年出现了令人信服的证据，表明 EVH 会导致移植物组织学特性较差。此外，一项观察性研究表明，EVH 导致的移植物狭窄明显更多，与更高的死亡率、更多的心肌梗死和更多的再介入相关。然而，最近的出版物无法证实这些发现，但是正在等待更大规模的、侧重于移植物质量的随机对照试验。
