内镜采集大隐静脉在CABG术中的应用及组织学评估

目的观察冠状动脉旁路移植术(CABG)中应用内窥镜采集大隐静脉对减少下肢切口并发症的效果,并通过组织学改变评价其安全性。方法2003年8月至2005年8月对256例CABG病人使用Va-soView5内窥镜系统采集大隐静脉。对常规切开及内窥镜采集的大隐静脉各10例的静脉近端和远端4mm做光镜和电子显微镜检查。结果全组病人无皮肤切口感染、下肢水肿、淋巴管炎和脂肪坏死等并发症发生。平均获取大隐静脉桥血管2.2支,平均耗时(45±20)d。平均卧床2~3d。光镜和电子显微镜显示的大隐静脉组织学结构差异不显著。结论CABG应用内窥镜采集大隐静脉能够减少创伤,明显降低术后下肢并发症,尤其对肥胖、糖尿病病人可降低术后感染的发生率,减轻术后下肢切口疼痛,提高病人术后活动能力,减少卧床与住院时间。且内窥镜方法和切开法具有同样的安全性。     

腔镜下大隐静脉隔绝术治疗大隐静脉曲张

目的:探讨腔镜下大隐静脉隔绝术治疗大隐静脉曲张的可行性及其疗效。方法:随机将2000年1月至2004年1月115例、132条下肢大隐静脉曲张患肢分为A、B两组,A组行腔镜下大隐静脉隔绝术,B组行传统的大隐静脉高位结扎剥脱术,对两种方法进行对比研究。结果:平均切口长度A组为(2. 0±0 .6)cm,B组为(8±1 .1)cm,平均切口长度A组明显短于B组(P<0 .05);平均手术时间A组为(35±10)min,B组为(90±17)min,手术时间A组明显短于B组(P<0 .05);术后两组症状消失,均未发生并发症;患者均获随访,随访1~36个月,A组无复发,B组局部复发4例,复发率6. 06%。结论:腔镜下大隐静脉隔绝术高位结扎、电灼大腿段大隐静脉,阻断其小腿段所有属支及交通支,使大隐静脉与体循环隔绝,不需抽剥大隐静脉,患者创伤小,疗效好,复发率低,是治疗大隐静脉曲张的理想术式。     

微创治疗下肢静脉曲张的手术配合及护理

目的探讨血管腔镜下及微创刨吸术（Trivex）在下肢静脉曲张的治疗方法中，能否减少腿部切口的并发症和重视手术配合的护理。方法对我院血管外科84例（共106条患肢）应用血管腔镜下交通支静脉结扎术（SEPS）及下微创刨吸术治疗下肢静脉曲张的病人中，观察术后病人腿部切口的愈合情况以及术中手术配合的护理要点。结果106条下肢静脉曲张的患肢应用Trivex微创刨吸术后．均无出现伤口和肢体软组织感染，38条患肢慢性溃疡术后约两周全部合．足踝部皮肤色素沉着逐步消退。结论术前充分的腔镜手术器械准备，术中娴熟的手术配合和护理是缩短手术时间提高手术成功率的重要保证之一。     

��׼�������������������Ľ�����336�����棩

目的评价和分析对大隐静脉剥脱术加以改进治疗大隐静脉曲张的疗效。方法首都医科大学附属北京安贞医院血管外科自2007年4月至2011年2月,应用改进的大隐静脉剥脱术治疗336例(418条肢体)大隐静脉曲张病人,并对术后并发症、术后复发等进行评价。结果平均每条肢体手术时间73min,术后并发症的发生率1.9%。病人术后症状明显减轻,随访3～12个月未见曲张静脉复发。结论改进的大隐静脉剥脱术是一种治疗大隐静脉曲张的有效措施,疗效肯定,并发症较少,术后复发率低。     

内镜下与常规切开法采集大隐静脉在冠状动脉旁路移植术中应用的比较

目的探讨内镜下采集大隐静脉应用于冠状动脉旁路移植术(coronary artery bypass grafting,CABG)中的早期临床效果。方法2004年4月~2005年5月,对89例采用内镜下取大隐静脉行CABG(内镜组),在膝关节中部做2 cm切口,应用VasoV iew 5内镜血管采集系统游离获取大隐静脉,并与2003年4月~2005年3月38例采用传统切开法取大隐静脉行CABG(常规组)进行比较,比较2组术后下肢切口并发症、恢复行走时间、患肢疼痛麻木感及肿胀、术后6个月通畅率。结果内镜组取大隐静脉2~3支,平均2.6支;内镜组下肢并发症(6例)与常规组(8例)相比明显减少(2χ=4.197,P=0.040);内镜组患肢疼痛、麻木感7例及肿胀9例与常规组(分别为36、30例)相比明显减少(2χ=89.740,P=0.000;2χ=59.299;P=0.000);内镜组恢复行走时间(2.3±0.9)d比常规组(3.4±1.6)d明显缩短(t=-4.952,P=0.000);内镜组术后6个月通畅率96.0%(48/50)与常规组95.3%(19/20)相比无明显差别(2χ=0.000,P=1.000)。结论CABG中应用内镜下采集大隐静脉能够减少创伤,明显降低术后下肢并发症,减轻术后下肢切口疼痛。     

颈内静脉——大隐静脉转流术治疗上腔静脉综合征

本文报告了２例良性上腔静脉综合征病人，采用颈内静脉－大隐静脉转流术，取得了成功。作者认为：由于良性上腔静脉综合征有梗阻范围广泛，常累及双侧无名静脉之特点，故采用此术式，对降低颈静脉高压、减轻面颈部浮仲有立罕见影之效果。用自体大隐静脉转流，取材方便，取材方便，创伤小，术后不需长期抗凝，远期疗效好，在基层医院便于开展。     

全程浅静脉连续缝扎治疗下肢静脉曲张

目的 改革传统术式，减少下肢静脉曲张手术的创伤。方法 通过Brpdie-Tren-delenburg及Perther试验及下肢静脉彩色多普勒超声检查等对确诊为下肢静脉曲张的83例患者、102条患肢进行了大隐静脉次高位结扎和经皮全程浅静脉连续环形缝扎术，而不做大隐静脉主干抽剥及曲张静脉的剥脱，以减少创伤。结果 该术式创伤小，术后恢复快，复发率低。结论 全程浅静脉缝扎是治疗单纯性大隐静脉曲张的一种可靠的微创手术方法，值得推广。     

间断小切口与传统长切口采集大隐静脉的临床比较

目的比较间断小切口与传统长切口采集大隐静脉在冠状动脉旁路移植术(CABG)中的应用,总结其临床经验。方法 2007年11月至2009年1月,北京阜外心血管病医院对47例冠心病患者行CABG,男37例,女10例;年龄43～78岁,平均年龄61.3岁。将47例患者随机分为两组,间断小切口组(n=21):在CABG中采用间断小切口法采集大隐静脉;传统长切口组(n=26):在CABG中采用传统长切口采集大隐静脉。比较两组切口长度、大隐静脉采集时间、下肢切口缝合时间和切口并发症等指标。结果两组在采集大隐静脉的过程中均未发生大隐静脉主干损伤及与移植血管质量相关的手术并发症。两组大隐静脉桥支数及大隐静脉长度差异无统计学意义;间断小切口组的大隐静脉采集时间较传统长切口组长(51.9±11.5minvs.40.3±7.6min,P=0.000),但切口总长度(16.1±4.1cmvs.49.2±7.2cm,P=0.000)、切口缝合时间(11.0±3.0minvs.33.6±4.8min,P=0.000)及下肢总手术时间(62.6±14.9minvs.73.8±11.6min,P=0.006)明显缩短。术后随访47例(100%),随访时间3～26个月。术后1个月间断小切口组和传统长切口组分别有4.8%(1/21)和34.6%(9/26)发生下肢切口不愈合、血肿、感染等并发症,经相应治疗后均愈合。间断小切口组切口并发症发生率低于传统长切口组(P0.05)。结论间断小切口技术采集大隐静脉不增加手术时间,并且有助于减少术后下肢切口并发症的发生。     

糖尿病患者行冠状动脉旁路移植术中应用腔镜采集大隐静脉的临床研究

目的探讨腔镜大隐静脉采集法(endoscopic vein harvesting,EVH)对糖尿病患者行冠状动脉旁路移植术(CABG)后恢复和桥血管再狭窄的影响。方法采用非随机临床对照研究的方法,纳入2010年12月至2012年2月华西医院行冠状动脉旁路移植术合并2型糖尿病的患者,按所采用的静脉桥血管采集方式,将患者分为腔镜大隐静脉采集法(EVH)组和开放大隐静脉采集法(CVH)组,评价两组患者围手术期并发症情况。随访期间采用介入或CT冠状动脉造影评价桥血管再狭窄情况。结果共纳入51例患者,其中EVH组24例,CVH组27例。两组患者年龄、体重、基础病变程度差异均无统计学意义。两组术中体外循环时间和主动脉阻断时间差异均无统计学意义[(67.2±9.8)min vs.(68.3±14.5)min,P>0.05;(62.4±11.3)min vs.(65.2±10.3)min,P>0.05]。两组患者术后主要并发症发生率差异无统计学意义。与CVH比较,EVH能显著缩短桥血管采集时间[(35.6±6.4)minvs.(45.2±11.4)min,P<0.05],降低腿部切口延迟愈合发生率[0.0%(0/24)vs.18.5%(5/27),P<0.05]。CVH组随访9.1个月,EVH组随访9.4个月。随访期间两组并发症(胸痛、大隐静脉再狭窄)发生率差异无统计学意义(P>0.05)。结论对于合并糖尿病行CABG的患者,EVH是一种安全有效、微创快速的桥血管采集方法。     

腔镜下筋膜腔内交通支离断术治疗原发性大隐静脉曲张并皮肤溃疡

目的：探讨腔镜下筋膜腔内交通支离断术治疗原发性大隐静脉曲张并皮肤溃疡的效果及优势。方法：对36例原发性大隐静脉曲张患者（52条患肢）实施腔镜下筋膜腔内交通支离断术和大隐静脉主干高位结扎及抽剥术治疗,观察溃疡的愈合、住院时间及复发情况。结果：术后住院时间5～14d（平均9.5d）。随访3～24个月,溃疡于术后7～58d（平均14.6d）内愈合,未见复发及新生溃疡。结论：腔镜下筋膜腔内交通支离断术和大隐静脉主干高位结扎及抽剥术安全有效,损伤小,并发症少。     

Leg wound infection after coronary artery bypass grafting: a meta-analysis comparing minimally invasive versus conventional vein harvesting

The great saphenous vein remains the most commonly harvested conduit for revascularization in coronary artery bypass grafting (CABG). Our aim is to compare minimally invasive vein harvest techniques to conventional vein harvest with regards to leg wound infection rates. A meta-analysis of identified randomized controlled trials, reporting a comparison between the two techniques published between 1965 and 2002, was undertaken. The outcome of interest was leg wound infection. Fourteen randomized studies were identified and included in the meta-analysis. Our study revealed that wound infection was significantly lower in the minimally invasive vein harvest group (odds ratio 0.22 with 95% confidence intervals of 0.14 to 0.34). Our study suggests that using minimally invasive techniques might reduce leg wound infection rate following great saphenous vein harvesting for CABG. Further research is required to evaluate the potential benefits of minimally invasive vein harvesting techniques on the cost of postoperative care and quality of the harvested vein.     

Leg wound infections following greater saphenous vein harvesting: minimally invasive vein harvesting versus conventional vein harvesting

Wound complications associated with long incisions used to harvest the greater saphenous vein are common and well documented. We compared leg wound infection rates, wound healing disturbances (WHDs), length of vein harvested, vein harvest time, and total surgical time between minimally invasive saphenous vein harvesting (MIVH) and conventional vein harvesting (CVH) techniques. This meta-analysis showed a significant reduction in wound infections in favor of the MIVH group (odds ratio = 0.19; 95% confidence interval = 0.14-0.25) and a significant reduction in WHDs in favor of the MIVH group (odds ratio = 0.26; 95% confidence interval = 0.20-0.34). The MIVH and CVH techniques are equivalent with respect to saphenous vein harvest time, saphenous vein harvest length, and total surgical time. A visual inspection of "funnel" plots suggests a mild to moderate publication bias. This meta-analysis suggests that leg wound infections and wound healing disturbances are reduced using MIVH techniques.     

Minimally invasive vein harvest and wound healing using the SaphLITE Retractor System

BACKGROUND: In response to reported wound complication rates of 19% to 43% for traditional saphenous vein harvest, several minimally invasive vein harvest (MIVH) techniques have been developed. The purpose of this investigation is to determine the effectiveness of one such MIVH technology, the Genzyme SaphLITE Retractor System (Genzyme Biosurgery, Cambridge, MA). METHODS: Since May 2000, saphenectomy was undertaken in 305 coronary artery bypass graft (CABG) patients using SaphLITE in a prospective, nonrandomized trial at three centers. Patients were assessed for wound healing (ASEPSIS tool) and incisional pain (numeric scale) through the postoperative visit. Harvest times, incision lengths, and vein lengths were recorded. RESULTS: ASEPSIS indicated satisfactory healing in 96.0%. Infection rate was 1.3% with four patients requiring antibiotics and debridement of one incision. Of hospitalized patients, 85.4% had no or minimal affected leg pain. Additional mean data include: harvest time 43.4 +/- 17.6 minutes, incision number 3.0 +/- 1.2, incision length 2.9 +/- 1.4 cm, and vein length 46.0 +/- 15.2 cm. CONCLUSIONS: SaphLITE provides an effective alternative to traditional saphenous vein harvest, with improved wound healing, decreased pain, and acceptable harvest times.     

电视内镜下获取大隐静脉在冠状动脉旁路移植术中的应用

目的 探讨冠状动脉旁路移植术(CABG)中应用微创电视内镜下获取大隐静脉的手术要点和临床效果.方法 自2001年1月至2008年12月212例患者接受CABG,按照获取大隐静脉的方法分为两组:内镜组72例,传统组140例.比较分析两组患者的手术资料和术后并发症等情况.结果 内镜组获取静脉的时间与传统组比较差异无统计学意...     

Minimally invasive saphenous vein harvest with the SaphLITE system

The method of harvesting the greater saphenous vein (GSV) through a long continuous incision is associated with a number of well-documented wound complications and significant postoperative pain. A randomized trial was developed to examine the outcome of standard harvesting techniques versus a minimally invasive harvesting technique using the SaphLITE system. Two hundred elective coronary artery bypass-graft patients were randomly placed into either a traditional saphenous vein harvest group (control) or a minimally invasive SaphLITE harvest group (study). Postoperative wound complications, patient discomfort, and length of follow-up were studied. Wound complications were greater in the control group compared with the study group (P < 0.025). Patient discomfort was markedly reduced in the study group. The postoperative follow-up was also reduced by an average of 8 weeks in the study group. The minimally invasive harvest of the greater saphenous vein with the SaphLITE system markedly reduced wound complication, patient discomfort, and length of postoperative follow-up.     

Endoscopic saphenous vein harvest decreases leg wound complication in coronary artery bypass grafting patients

A bstract Background: Coronary artery bypass grafting (CABG) is the most common procedure performed in adult cardiovascular surgery. The most frequently used conduit is the greater saphenous vein. Using traditional methods, the complication rate of the leg is relatively high (up to 24%). To decrease the complication rate, we used the Endo-Path to harvest the greater saphenous vein. Methods and Results: From May 1997 through March 1999, a total of 135 patients received the CABG operation. We excluded the patients who died immediately postoperatively or had concomitant surgical procedures. Sixty patients received the endoscopic saphenous vein harvest procedure (group A), while another 59 patients (group B) did not. No important differences were noted between the two groups in respect to the number of distal anastomoses, length of harvested vein, total surgical time, and length of ICU stay. However, the leg wound complication rate decreased from 20.3% to 5.0% (p < 0.001). Conclusions: Although the long-term patency rate needs time to be proven, the endoscopic greater saphenous vein harvest method is an attractive and effective method.     

Minimally invasive vein harvesting significantly reduces pain and wound morbidity.

OBJECTIVES: Minimally invasive saphenous vein harvesting is advocated to reduce wound morbidity. Our early experience with minimally invasive techniques, however, suggested that increased tissue traction and trauma might follow. We aimed to test the hypothesis that minimally invasive harvesting reduces post-operative pain and inflammation. A secondary objective was to determine if minimally invasive harvesting could be performed efficiently. METHODS: Forty patients were prospectively randomised into minimally invasive harvesting (Minimal, n=22) and traditional open harvesting (Open, n=18). A modified bridging technique was used for minimally invasive harvesting (SaphLITE, Genzyme Surgical Products, Cambridge, MA, USA). One surgeon performed all operations. Primary end points were signs of impaired healing (a composite score) and pain (visual analogue score). Secondary end-points (operation variables) were also collected. Continuous variables were analysed by Student's t-test and categorical variables were analysed by Mann-Whitney U-test. RESULTS: There were no significant demographic differences between the two groups (height, weight, albumin, diabetes, and peripheral vascular disease). In the early post-operative period, Minimal group had significantly less leg wound pain (P=0.04) and wound sepsis scores (P=0.01). Sternal pain was the same in both groups. After 6 weeks, wound scores and leg pain scores were not significantly different. There were no significant differences in rate of harvest (1.1 cm/min in each group). In Minimal group, 4 cm veins were harvested for each 1 cm skin incision compared with 1 cm in Open group (P<0.01). CONCLUSIONS: Minimally invasive saphenous vein harvesting significantly reduces early post-operative leg pain and wound sepsis. Our study demonstrates that minimally invasive harvesting can be performed at a satisfactory speed and should be considered to help reduce early post-operative morbidity.     

A prospective randomized trial of endoscopic versus open saphenous vein harvesting technique for coronary artery bypass graft surgery

Purpose

The great saphenous vein harvested with a traditional open technique often results in leg wound complications. An endoscopic harvesting technique may decrease incidence of these complications.

Methods and material

Fifty consecutive patients having elective primary coronary artery bypass surgery were prospectively and randomly assigned to either endoscopic great saphenous vein harvesting (EVH—group A) or open great saphenous vein harvesting (OVH—group B). Both groups were demographically similar and received identical management. Leg wound healing was evaluated at discharge, 1 week, 1 month and 6 months for evidence of complications.

Result

The patient in endoscopic vein harvesting group had increased harvest time and an insignificant increase in vein injuries at the time of harvesting but decreased incision closure times when compared with traditional longitudinal open vein harvesting. Conversion from endoscopy to a traditional longitudinal open vein harvest occurred in 5 % of patients. Leg wound complications were significantly reduced postoperatively in the endoscopic vein harvesting group in comparison with the open vein harvesting group. Histological evaluation of structural integrity of vein samples shows that there is no significant difference between both the groups. No patient was readmitted to the hospital for leg wound complications in either group.

Conclusion

EVH is a safe, reliable method for saphenous vein harvesting. The best indication for EVH may be in patients who are in increased risk for wound infection and in whom cosmetics is a major concern.

     

Experiences of minimally invasive great saphenous vein graft harvest using with endopath

We have experienced 20 cases of minimally invasive great saphenous vein graft harvest using with endoscopy, Endopath, from March 1999. As we experienced cases, we can harvest great saphenous vein graft, about 30-40 cm in size, from only two 4-cm incisions for about 50 minutes. There are no wound infection, pain, and edema. Great saphenous vein graft harvesting with Endopath is less invasive, painless after surgery and makes patients satisfied about cosmetic problem.     

Early experience of endoscopic vein harvesting for CABG

Objectives As the traditional method of saphenous vein harvesting is associated with nagging leg wound problems, we tried to incorporate this relatively new technique of endoscopic vein harvesting (EVH) in to our regular coronary artery bypass grafting (CABG) Programme. Methods Selected patients (based on affordability, obesity, availability of operator and vein quality on inspection) were offered endoscopic vein harvesting (EVH) for CABG. Vasoview 6 (Guidant, U.S.A) Endoscopic dissector was used with carbon dioxide insufflation. As this was our initial experience, only thigh veins were tried. If additional veins were required or the endoscopically harvested veins were of unacceptable quality, additional vein was harvested by open method. Impacts on cost and operative time, discard rate and leg wound complications were noted. Results We have so far attempted EVH on 86 patients. In one (first), the whole vein had to be discarded and in two others, parts of the vein were not used. Additional vein harvesting was done in 4 patients. EVH was converted to Vein stripping in one patient due to bleeding while branch division and poor visibility. No leg wound complications occurred in any of these patients. Additional time spent was approximately 45–50mts in the first few patients. Of late this has reduced to 25–30 mts. Additional material cost was Rs.3000 per patient. Conclusion With experience, EVH can be a valuable additional tool in the CABG set up with the advantage of reduced leg incision and consequent reduction in leg wound problems with minimal increase in the operative time and cost.