内窥镜与直视获取大隐静脉的应用比较

目的比较内窥镜下与常规切开采集大隐静脉应用于冠状动脉搭桥术(CABG)中的早期临床效果。方法 2005年1月～2010年4月,对124例采用内镜下取大隐静脉行CABG(EVH组),在膝关节中部做2cm切口,应用米道斯内窥镜血管采集系统游离获取大隐静脉,并与同期110例采用传统切开法取大隐静脉行CABG(常规组)进行比较,对比2组总手术时间、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、术后住院天数、手术费用。结果总手术时间EVH组为(273.5±34.7)分,常规组为(279.1±27.9)分,2组比较差异无显著性。EVH组术后下肢切口并发症(12例)与常规组(37例)相比明显减少;EVH组患肢疼痛麻木感16例及肿胀20例与常规组(分别为48、57例)相比明显减少;EVH组恢复行走时间(2.6±0.2)天比常规组(3.8±1.3)天明显缩短;EVH组术后住院天数(10.4±0.7)天比常规组(13.3±2.6)天明显缩短;EVH组手术费用比常规组增加约1.3万元。结论 CABG中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,减轻术后下肢切口疼痛及肿胀、缩短术后住院时间,但增加住院费用。

Comparison of endoscopic and conventional great saphenous vein harvesting in coronary artery bypass grafting

Objective To compare the clinical effects of endoscopic and conventional great saphenous vein harvesting in coronary artery bypass grafting.Methods Endoscopic great saphenous vein harvesting was performed in 124 patients undergoing coronary artery bypass grafting(CABG)from Jan.2005 to April 2010.An incision 2cm in length was made on the knee joint and the great saphenous vein was harvested using the Medos system.Clinical data of the 124 patients(EVH Group)were compared with another 110 patients underwent conventional great saphenous vein harvesting for CABG from Jan.2005 to April 2010(Conventional Group)in respect of operating time,complications of the leg,the recovery time to walking,stay in hospital time and cost of operation.Results The operting time in two groups was no significant(273.5±34.7)min vs(279.1±27.9)min.Complications of the leg were significantly less in the EVH Group(12/124)than in the Conventional Group(37/110).The occurrence of pain and numbness of the leg was 16/124 in the EVH Group and 48/110 in the Conventional Group.The occurrence of swelling of the leg was 20/124 in the EVH Group and 57/110 in the Conventional Group.The recovery time to walking was significantly shorter in the EVH Group(2.6±0.2d)than in the ConventionalGroup(3.8±1.3)d.The stay time in hospital was significantly shorter in the EVH Group(10.4±0.7)d than in the Conventional Group(13.3±2.6)d.The cost of operation in EVH group was moer 13 thousand yuan than in conventional group.Conclusion Use of endoscopic vein harvesting in coronary artery bypass grafting decreased the incidence of postoperative leg-wound infections,post-operative pain,and length of hospital stay,but increased the cost of operation.