Tevaearai H T, Mueller X M, von Segesser L K
Service de Chirurgie Cardio-Vasculaire, Centre Hospitalier Universitaire Vaudois, Lausanne.
Swiss Surg. 1998;Suppl 2:8-11.
Harvesting of the great saphenous vein for coronary artery bypass grafting is usually performed through long cutaneous incisions. We report our experience of minimally invasive harvest of the saphenous vein using the "Mini Harvest System". This device is composed of a blade coupled to a light source. Through a small cutaneous incision, the blade is placed under the skin and allows progressive dissection of the vein under direct vision. We compare this technique ("minimal invasive" group, n = 48) to the conventional method in which extensive incisions are performed along the saphenous vein course ("standard", n = 54). Both groups are comparable in term of age, sex, diabetes, peripheral arterial disease or obesity. The number of bypass performed is also comparable in the two groups. The ratio of the mean length of the cutaneous incision and the mean length of the vein was 35.4 +/- 5.9% for the "minimal invasive" group and 104.5 +/- 23.3% for the "standard" group (p < 0.001). The local complication rate is significantly reduced with a reduction in local post-operative pain (2% vs. 17%, p = 0.01), a better healing (100% vs. 79%, p = 0.01), a reduction in hematoma (31% vs. 52%, p = 0.03) and in oedema (37% vs. 59%, p = 0.03). We conclude that besides the evident aesthetic benefit, minimally invasive harvest of the saphenous vein allows for a better cicatrization and reduces the post-operative discomfort without compromising the aorto-coronary bypass procedure.
用于冠状动脉搭桥术的大隐静脉采集通常通过长皮肤切口进行。我们报告了使用“迷你采集系统”微创采集大隐静脉的经验。该设备由与光源相连的刀片组成。通过一个小皮肤切口，将刀片置于皮下，可在直视下逐步分离静脉。我们将该技术（“微创”组，n = 48）与沿大隐静脉走行进行广泛切口的传统方法（“标准”组，n = 54）进行比较。两组在年龄、性别、糖尿病、外周动脉疾病或肥胖方面具有可比性。两组进行搭桥手术的数量也相当。“微创”组皮肤切口平均长度与静脉平均长度之比为35.4±5.9%，“标准”组为104.5±23.3%（p < 0.001）。局部并发症发生率显著降低，局部术后疼痛减轻（2%对17%，p = 0.01），愈合更好（100%对79%，p = 0.01），血肿减少（31%对52%，p = 0.03），水肿减少（37%对59%，p = 0.03）。我们得出结论，除了明显的美学益处外，大隐静脉的微创采集可实现更好的瘢痕形成，减少术后不适，且不影响主动脉冠状动脉搭桥手术。
