Kiaii Bob B, Swinamer Stuart A, Fox Stephanie A, Stitt Larry, Quantz Mackenzie A, Novick Richard J
From the *Departments of Surgery, Western University, London, ON Canada; and †Department of Surgery, University of Calgary, Calgary, AL Canada.
Innovations (Phila). 2017 Jul/Aug;12(4):231-238. doi: 10.1097/IMI.0000000000000386.
The aims of the study were to determine whether endoscopic harvesting of the radial artery (RA) reduces morbidity due to pain, infection, and disability with improvement in satisfaction and cosmesis compared to the conventional technique and (2) to compare the 6-month angiographic patency of the RA harvested conventionally and endoscopically.
In a prospective randomized study, 119 patients undergoing coronary artery bypass grafting using the RA were randomized to have RA harvested either conventionally (n = 59) or endoscopically (n = 60).
Radial artery harvest time (open wound time) was significantly reduced in the endoscopic group (36.5 ± 9.4 vs 57.7 ± 9.4 minutes, P < 0.001). Only one patient developed wound infection (1.6%) in the endoscopic group compared with six patients (10.2%), P = 0.061, in the conventional group. Although this was not statistically significant, clinically this was relevant in terms of reduction in postoperative morbidity. Postoperative pain in the arm incision was significantly lower in the endoscopic group at postoperative day 2 (P < 0.001) and at discharge (P < 0.001) and similar to the conventional open group at 6 weeks' follow-up (P = 0.103). Overall patient satisfaction and cosmesis were significantly better in the endoscopic group at postoperative day 2 (P < 0.001), at discharge (P < 0.001), and at 6 weeks' follow-up (P < 0.001). There was no difference in the arm disability postoperatively (P = 0.505) between the two groups. Six-month angiographic assessment of 23 patients (12 endoscopic and 11 open) revealed no difference in the patency rate (10/12 in endoscopic and 9/11 in open group).
Endoscopic RA harvesting reduced the incidence of postoperative wound infection and wound pain and improved patient satisfaction and cosmesis compared with conventional harvesting technique. There was no difference in the 6-month angiographic patency of the RA harvested conventionally and endoscopically.
本研究旨在确定与传统技术相比，内镜下获取桡动脉（RA）是否能降低因疼痛、感染和功能障碍导致的发病率，同时提高患者满意度和美观度；（2）比较传统方法和内镜下获取的RA在6个月时的血管造影通畅率。
在一项前瞻性随机研究中，119例行冠状动脉旁路移植术并使用RA的患者被随机分为传统方法获取RA组（n = 59）和内镜下获取RA组（n = 60）。
内镜组桡动脉获取时间（开放伤口时间）显著缩短（36.5±9.4分钟对57.7±9.4分钟，P < 0.001）。内镜组仅1例患者发生伤口感染（1.6%），而传统组有6例患者发生（10.2%），P = 0.061。虽然这在统计学上无显著差异，但在临床上对降低术后发病率具有重要意义。内镜组术后第2天（P < 0.001）和出院时（P < 0.001）手臂切口的术后疼痛明显低于传统组，在6周随访时与传统开放组相似（P = 0.103）。内镜组在术后第2天（P < 0.001）、出院时（P < 0.001）和6周随访时（P < 0.001）的总体患者满意度和美观度均显著优于传统组。两组术后手臂功能障碍无差异（P = 0.505）。对23例患者（12例内镜下获取组和11例传统获取组）进行的6个月血管造影评估显示，通畅率无差异（内镜下获取组为10/12，传统获取组为9/11）。
与传统获取技术相比，内镜下获取RA可降低术后伤口感染和伤口疼痛的发生率，并提高患者满意度和美观度。传统方法和内镜下获取的RA在6个月时的血管造影通畅率无差异。
