内窥镜取大隐静脉技术应用于不同静脉管径下的对比性分析

目的   对比分析应用内窥镜取大隐静脉技术（ESVH）时静脉管径差异对手术进程及血管条件所造成的影响。方法   选取2011至2012年于我院进行的内窥镜取大隐静脉管径(SV)病例80例，根据术前超声测量的SV管径差异将病例分为A组（管径<3mm，19例）与B组（管径≥3mm，61例），记录内窥镜手术所用时间及单纯采集静脉时间，及血管分支数、结扎分支数、修补分支数、桥血管长度等血管条件指标。术后光镜下观察两组静脉内膜结构，扫描电镜观察静脉内膜损伤，TUNEL法检测两组细胞近期凋亡。结果   小静脉管径组有更多的分支（A：12.9±3.2；B：6.3±4.1，P<0.05），冠状动脉搭桥所用桥血管长度、各组修补所占比率差异无统计学意义（P>0.05），两组内窥镜取SV耗时差异有统计学意义［A：（59.5±12.8）min；B：（41.9±15.4）min， P<0.05］，而其单纯静脉采集时间无差异（P>0.05）， 光镜和扫描电镜观察检测血管组织学差异，血管损伤组织学差异更显著（P<0.05），TUNEL凋亡检测示近期血管凋亡水平差异无统计学意义（P>0.05）。结论   与大管径SV相比，管径<3mm的SV应用ESVH需要更长的手术时间，同时对血管也造成相应的损伤， 其采集更适合应用传统开放手术。

Comparative study of endoscopic saphenous vein harvesting applied to different vein calibers

Objective   To compare the influence of saphenous diameters on the operative progress and vessel condition of endoscopic saphenous vein harvesting (ESVH). Methods   The clinical cases of 80 patients who were treated with ESVH from 2011 to 2012 in our hospital were investigated. Patients were divided into two groups by preoperative ultrasound: group A (SV caliber <3mm, n=19), and group B (SV caliber≥3mm, n=61). Total procedure time and EVSH time, SV characteristics such as the total number of side branches, number of ligated branches, number of repaired branches, and total graft length were recorded in the operating room.Light microscopy was used to observe the structure of the vein intima, scanning electron microscopy was used to assess the trauma of the vein intima, and the cell apoptosis was detected by TUNEL assay. Results   Group A had a larger number of side branches (A, 12.9±3.2; B, 9.3±4.1，P<0.05), but graft length ［A, (28.2±3.9)cm; B, (27.7±3.1)cm］ and ratio of repaired side branches relative to total branches per graft ［A, (20.3±9.1)%; B, (18.5±8.0)%］ showed no significant inter-group differences（P>0.05）. Group A patients required a longer operating time ［A, (59.5±12.8)min; B, (41.9±15.4)min］, but EVSH time showed no difference（P>0.05）.Vascular histological injury was statistically significant(P<0.05)，but the cell apoptosis detected by TUNEL assay showed no significant differences(P>0.05). Conclusion   SV with a caliber of <3mm prolong the procedure time and injure the quality of SV in comparison with SV measuring ≥3mm in caliber. So SV with a small caliber is less appropriate for ESVH and is better harvested by a conventional open procedure.