不接触大隐静脉获取术、内镜辅助下获取大隐静脉及切开法获取大隐静脉技术获取冠脉旁路移植血管在非体外循环冠状动脉旁路移植术中的疗效对比研究  

A comparison of the efficacy of No-touch,EVH,and OVH techniques for obtaining coronary artery bypass grafts in OPCABG patients

作　　者：丁付燕[1] 孟树萍[1] 刘超[1] 刘富荣[1] 朱佳璐 胡延磊 DING Fuyan;MENG Shuping;LIU Chao;LIU Furong;ZHU Jialu;HU Yanlei(Heart Center of He′nan Provincial People′s Hospital,Adult Cardiovascular Surgery Intensive Care Unit of Huazhong Fuwai Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院心脏中心/华中阜外医院成人心血管外科,郑州450003

出　　处：《实用医学杂志》2021年第21期2770-2774,共5页The Journal of Practical Medicine

基　　金：河南省医学科技攻关项目(编号:LHGJ20200093)。

摘　　要：目的探究不接触大隐静脉获取术(non-touch acquisition technology,No-touch)、内镜辅助下获取大隐静脉(endoscopic vein harvesting,EVH)及传统切开法获取大隐静脉(open vein harvesting,OVH)技术获取冠脉旁路移植血管在非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)中的疗效。方法选取2017年1月至2019年10月收治的应用大隐静脉作旁路移植材料、择期行OPCABG的患者268例。根据静脉获取方式分为3组,No-touch组91例、OVH组89例和EVH组88例。观察术后切口、并发症及随访情况。结果 EVH切口大小明显小于No-touch组、OVH组;EVH组围术期、术后6个月及1年随访,腿部切口并发症发生率明显低于No-touch组、OVH组(P <0.05);No-touch组近期通畅率较EVH组、OVH组相比差异有统计学意义(P <0.05);手术时间No-touch组与OVH组在获取大隐静脉的时间上的差异有统计学意义(P <0.05);形态结构对比,No-touch组与EVH组较OVH组血管内皮细胞保留更完整。结论三种大隐静脉获取术中,EVH在切口大小、围术期及术后并发症方面较No-touch组、OVH组存在明显优势;光镜下No-touch组与EVH组血管内皮细胞保存更为完整,临床上EVH术安全性和可行性相对较高。Objective To explore the effect of coronary artery bypass grafting in off-pump coronary artery bypass grafting(OPCABG)using non-touch acquisition technology(No-touch),endoscopic-assisted acquisition of the great saphenous vein(EVH),and traditional incision method to obtain the great saphenous vein(OVH).Methods A total of 268 patients who were treated with the great saphenous vein as bypass graft material and elective OPCABG were selected from January 2017 to October 2019. They were divided into three groups based on the vein acquisition method,with 91 cases in the No-touch group,89 cases in the OVH group,and 88 cases in the EVH group. The postoperative incision,complications and follow-up were observed. Results The size of the EVH incision was significantly smaller than that of the No-touch group and the OVH group;during the perioperative,6-month and 1-year follow-up of the EVH group,the incidence of leg incision complications was significantly lower than that of the No-touch group and the OVH group(P < 0.05);the recent patency rate of the No-touch group was statistically significant compared with the EVH group and the OVH group(P < 0.05);the operation time of the Notouch group and the OVH group were statistically different in the time to obtain the great saphenous vein Scientific significance(P < 0.05);morphological structure comparison,No-touch group and EVH group have more complete vascular endothelial cells than OVH group. Conclusion In the three types of great saphenous vein harvesting operations,EVH has obvious advantages over No-touch group and OVH group in terms of incision size,perioperative period and postoperative complications;No-touch group and EVH group have vascular endothelial cells preservation under light microscope more complete and clinically. EVH is relatively safe and feasible.

关 键 词：大隐静脉获取术 冠状旁路移植术 不接触大隐静脉获取术 内镜获取 

分 类 号：R615[医药卫生—外科学]