No-touch与EVH获取大隐静脉桥血管的近中期临床结果分析

目的 比较no-touch和内窥镜获取（endoscopic vein harvesting, EVH）两种不同的大隐静脉移植物获取方式对冠状动脉旁路移植术（coronary artery bypass grafting, CABG）术后早期临床效果及近中期移植物通畅率的影响。 方法 回顾性分析西安交通大学第一附属医院心血管外科2018年7月至2019年12月行CABG患者151例，其中no-touch技术组获取大隐静脉56例；EVH组获取大隐静脉95例。所有患者采取胸骨正中切口入路，非体外或体外循环辅助下完成搭桥手术。统计两组间平均桥血管远端吻合口数量、左乳内动脉吻合口数量及静脉桥远端吻合数量的差异；分析比较两组术后死亡及早期并发症发生情况以及术后切口并发症如血肿、脂肪液化等差异。患者出院前及术后1年行冠脉动脉CT血管成像检查（CTA）以评估移植血管桥近中期的通畅情况。 结果 No-touch和EVH两组在年龄、性别构成、危险因素、术前诊断类型等方面均无统计学差异。术中两组左乳内动脉吻合口数量及静脉桥远端吻合数量等差异均无统计学意义。两组均无手术死亡。在术后早期并发症方面无显著性差异；但在下肢切口并发症中水肿、切口处麻木、疼痛在no-touch组中尤为显著（P<0.05）。术后冠脉CTA复查提示，术后早期桥血管总体通畅率、两组间左乳内动脉及大隐静脉桥血管通畅率均无差异。术后1年总体桥血管通畅率no-touch组要优于EVH组（P<0.05），其中左乳内动脉通畅率无差异，大隐静脉桥血管no-touch组通畅率要明显高于EVH组（P<0.05）。 结论 No-touch技术获取静脉桥血管对于CABG患者的近、中期临床效果满意，且中期桥血管通畅率要优于EVH组。该技术可行、安全、有效，值得在CABG中进一步推广。

Analysis of immediate and mid-term clinical results of great saphenous vein graft harvested by No-touch technique and endoscopic vein harvesting technique

AIM To compare the effects of two different great saphenous vein (SVG) harvesting methods (No-touch technique and endoscopic vein harvesting technique) on immediate post-operative clinical results and immediate/mid-term graft patency after coronary artery bypass grafting (CABG). METHODS One hundred and fifty-one patients undergoing CABG surgery in the Department of Cardiovascular Surgery, First Affiliated Hospital of Xi’an Jiaotong University were retrospectively reviewed, including 56 cases of no-touch technique and 95 cases of endoscopic vein harvesting (EVH) technique. All surgeries were approached from median sternotomy with or without the help of cardiopulmonary bypass. The median number of distal anastomoses, the number of left internal thoracic artery (ITA) anastomoses and the number of SVG anastomoses were calculated and compared between the two groups. Early mortality, post-operative complications and leg wound complications such as hematoma and fat liquefaction were also compared between the two groups. Coronary computed tomographic angiography were conducted before discharge and 1 year after surgery to evaluate immediate and mid-term graft patency. RESULTS There were no significant differences in terms of age, gender, risk factors or pre-operative diagnoses. Also there were no significant differences in the number of left ITA anastomoses or number of SVG anastomoses between the two groups. No operative deaths occurred in either group. There were no significant differences in early post-operative complications except in leg wound complications. Leg edema, incision numbness and pain were significantly higher in no-touch group (P<0.05). There were no significant differences in post-operative immediate total graft patency rate, left ITA graft patency rate and SVG graft patency rate. But total graft patency rate during one-year coronary CTA assessment in no-touch group was higher than that in EVH group (P<0.05) and left ITA graft patency rate was the same in both groups. The rate of mild and moderate stenosis was higher in EVH group (P<0.05). CONCLUSION The immediate and mid-term clinical results of SVG graft harvested by no-touch technique in CABG are satisfactory and its mid-term graft patency rate is better than that by EVH technique. No-touch technique is feasible, safe and worthy of wide use for CABG.