非体外循环冠状动脉旁路移植术中不同方式获取大隐静脉的近中期临床效果  

Effect of different great saphenous vein harvesting procedures on short-and middle-term clinical outcomes of OPCABG

作　　者：高峰[1] 庄熙晶[1] 高洋[1] 石磊[1] Gao Feng;Zhuang Xijing;Gao Yang;Shi Lei(Deparment of Cardiovascular Surgery,Dalian Central Hospital,Dalian Municipal 116033,Liaoning Province,China)

机构地区：[1]大连市中心医院心脏大血管外科

出　　处：《中华老年心脑血管病杂志》2019年第10期1050-1053,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的分析非体外循环冠状动脉旁路移植术(OPCABG)不同方式获取大隐静脉的近期和中期临床效果。方法选择在我科接受择期OPCABG的患者435例,根据获取大隐静脉的方式,分为内窥镜获取大隐静脉(edoscopic vein harvesting,EVH)组217例及开放式获取大隐静脉(open vein harvesting,OVH)组218例,比较2组围术期病死率、急性心肌梗死、低心排综合征和腿部切口并发症等不良事件发生率,随访6个月和1年,比较2组静脉桥血管狭窄或闭塞比例和腿部切口并发症。结果 EVH组围术期腿部切口并发症发生率明显低于OVH组(2.30%vs 12.84%,P=0.000)。EVH组与OVH组围术期病死率(1.38%vs 2.29%,P=0.724)、急性心肌梗死(1.38%vs1.83%,P=1.000)和低心排综合征发生率(1.84%vs 2.75%,P=0.751)比较,差异均无统计学意义。术后6个月随访,EVH组与OVH组发生桥血管狭窄或闭塞比例比较,差异无统计学意义(8.76%vs 9.17%,P=1.000),EVH组腿部切口相关并发症发生率明显低于OVH组(3.69%vs 17.89%,P=0.000)。术后1年随访,EVH组与OVH组发生桥血管狭窄或闭塞比例比较,差异无统计学意义(11.52%vs 14.22%,P=0.475),EVH组腿部切口相关并发症发生率明显低于OVH组(5.53%vs 25.69%,P=0.000)。结论 EVH与OVH围术期不良事件发生率相似,但EVH术后腿部切口相关并发症发生率低于OVH,较OVH有明显优势。Objective To analyze the effect of different great saphenous vein harvesting procedures on short-and middle-term clinical outcomes of off-pump coronary artery bypass graft(OPCABG).Methods Four hundred and thirty-five patients who underwent OPCABG in our hospital were divided into edoscopic vein harvesting(EVH)group(n=217)and open vein harvesting(OVH)group(n=218).The incidence of adverse events(mortality,AMI,low cardiac output syndrome,and leg incision-related complications)was compared between the two groups.The patients were followed up for 6 and 12 months respectively,during which the incidence of stenosis and occlusion of great saphenous vein was compared.Results The perioperative incidence of leg incision-related complications was significantly lower in EVH group than in OVH group(2.30%vs 12.84%,P=0.000).No significant difference was detected in perioperative mortality,incidence of AMI,low cardiac output symdrome,and incidence of stenosis and occlusion of great saphenous vein between the two groups(1.38% vs 2.29%,P=0.724;1.38% vs 1.83%,P=1.000;1.84%vs 2.75%,P=0.751;8.76%vs 9.17%,P=1.000)and the incidence of leg incision-related complications was significantly lower in EVH group than in OVH group during the 6-month follow-up period(3.69%vs 17.89%,P=0.000).No significant difference was detected in the incidence of stenosis and occlusion of great saphenous vein between the two groups(11.52%vs 14.22%,P=0.475)and the incidence of leg incision-related complications was significantly lower in EVH group than in OVH group during the 12-month follow-up period(5.53%vs25.69%,P=0.000).Conclusion The perioperative incidence of adverse events is similar between OVH group and EVH group.However,the incidence of leg incision-related complications is significantly lower after EVH than after OVH,indicating that EVH is significantly advantageous to OVH for harvesting great saphenous vein.

关 键 词：冠心病 冠状动脉旁路移植术 非体外循环 血管移植术 围手术期 大隐静脉血管桥 

分 类 号：R654.2[医药卫生—外科学]