Navia J L, Brozzi N, Chiu J, Blackstone E H, Atik F A, Svensson L G, Gillinov A M, Hanson G L, Al-Ruzzeh S, Feng J, Lytle B W
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44195, USA.
J Cardiovasc Surg (Torino). 2012 Apr;53(2):257-63.
The radial artery has become the artery of choice after the internal thoracic artery for coronary artery bypass grafting (CABG). This study compares wound healing and arm complications after endoscopic versus open radial artery harvesting for CABG.
From January 2002 to July 2004, 509 patients underwent CABG in which a radial artery conduit was used. Thirty-nine had endoscopic and 470 had conventional open radial artery harvesting. A propensity score was used to obtain 1:3 matching of all endoscopic to 117 open-harvesting patients. Postoperative wound healing using the Hollander scale, local neurologic deficits, wound infection, and pain scores were compared.
Wound healing: 34 of 39 endoscopic wounds exhibited a perfect Hollander score versus 339 of 470 open-harvest wounds (P=0.01). Wound appearance in particular was better than for open harvesting (P=0.004), with no abnormal step-off borders, irregular contours, or abnormal scar width observed. Neurologic deficits. Three incomplete neurologic deficits were observed after open harvesting (two being distal sensitivity localized in the interspace between the first and second metacarpals); one complete neurologic deficit occurred after endoscopic harvesting, but improved remarkably prior to hospital discharge. Wound infection. Occurrence of wound infection was similar in the two groups (P=0.7), although infection was more severe with open harvesting. Pain: pain score was lower (P=0.006) with endoscopic harvesting.
Compared with conventional open harvesting, endoscopic radial artery harvesting was associated with better wound appearance and less pain. Occurrence of neurologic deficits and wound infection was infrequent in both groups.
桡动脉已成为继胸廓内动脉之后冠状动脉旁路移植术（CABG）的首选动脉。本研究比较了冠状动脉旁路移植术采用内镜下与开放获取桡动脉后的伤口愈合情况及手臂并发症。
2002年1月至2004年7月，509例行冠状动脉旁路移植术的患者使用了桡动脉导管。39例采用内镜获取桡动脉，470例采用传统开放方式获取桡动脉。采用倾向评分法对所有内镜获取组与117例开放获取组患者进行1:3匹配。比较两组术后使用霍兰德量表评估的伤口愈合情况、局部神经功能缺损、伤口感染及疼痛评分。
伤口愈合：39例内镜下获取桡动脉的伤口中有34例霍兰德评分完美，而470例开放获取桡动脉的伤口中有339例（P = 0.01）。尤其是伤口外观优于开放获取组（P = 0.004），未观察到异常的台阶状边缘、不规则轮廓或异常瘢痕宽度。神经功能缺损：开放获取桡动脉后观察到3例不完全性神经功能缺损（2例为第一和第二掌骨间隙远端感觉异常）；内镜获取桡动脉后出现1例完全性神经功能缺损，但在出院前显著改善。伤口感染：两组伤口感染发生率相似（P = 0.7），尽管开放获取组感染更严重。疼痛：内镜获取桡动脉时疼痛评分更低（P = 0.006）。
与传统开放获取相比，内镜下获取桡动脉伤口外观更好，疼痛更轻。两组神经功能缺损和伤口感染发生率均较低。
