Grus T, Lambert L, Grusová G, Rohn V, Lindner J
2nd Department of Surgery - Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
Prague Med Rep. 2011;112(2):115-23.
The aim of the study was to compare three different methods of radial artery harvesting with regard to postoperative complications and perioperative stress of the patient. A total of 60 patients admitted for coronary artery bypass surgery were randomized into three groups. Each patient underwent extraction of radial artery, all performed by a single surgeon. The radial artery was harvested by one of the following three techniques: classical technique (20 patients), mini-invasive technique (20), and endoscopic technique (20). The time required for the graft harvest was greater in the group where the endoscopic technique was used (52.6 ± 11.3 min) than with the mini-invasive (41.5 ± 7.3 min) or the classical (27.8 ± 4.6 min) technique. Postoperative blood loss into drains was higher where the classical technique was used (35.5 ± 9.4 ml) as compared to the mini-invasive (20 ± 5 ml) or the endoscopic (10 ± 7.3 ml) technique. There was no significant difference among the groups in the rate of local neurological complications, contusion of wound edge, edema of the extremity, or wound infection rate. We observed no case of ischemia of the extremity, and a single case of postoperative myocardial ischemia in the group where the classical technique was used. From a clinical point of view, the mini-invasive and the endoscopic approach are comparable, but the latter is more expensive. Both mini-invasive and endoscopic techniques prolong the operation, reduce perioperative blood loss, and require additional training time.
本研究的目的是比较三种不同的桡动脉获取方法在术后并发症和患者围手术期应激方面的差异。共有60例因冠状动脉搭桥手术入院的患者被随机分为三组。每位患者均接受桡动脉提取，均由同一位外科医生操作。桡动脉通过以下三种技术之一获取：经典技术（20例患者）、微创技术（20例）和内镜技术（20例）。使用内镜技术的组（52.6±11.3分钟）获取移植物所需的时间比微创技术组（41.5±7.3分钟）或经典技术组（27.8±4.6分钟）更长。与微创技术组（20±5毫升）或内镜技术组（10±7.3毫升）相比，使用经典技术组术后引流管失血更多（35.5±9.4毫升）。各组在局部神经并发症发生率、伤口边缘挫伤、肢体水肿或伤口感染率方面无显著差异。我们未观察到肢体缺血病例，在使用经典技术的组中出现了1例术后心肌缺血病例。从临床角度来看，微创方法和内镜方法具有可比性，但后者成本更高。微创技术和内镜技术均会延长手术时间、减少围手术期失血，且需要额外的培训时间。
