屈膝屈髋、髋关节内旋体位在小隐静脉取材术中的应用  

Application of Flexion at the Knee and Hip Level and Internal Rotation at the Hip Joint for Lesser Saphenous Vein Harvesting

作　　者：郝兴海[1] 任长伟[1] 周元[1] 贾明[1] 来永强[1] Hao Xinghai;Ren Changwei;Zhou Yuan(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,北京100029

出　　处：《中国微创外科杂志》2023年第5期384-389,共6页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨屈膝屈髋、髋关节内旋体位进行小隐静脉(lesser saphenous vein,LSV)取材的安全性和可行性。方法2014年1月~2022年10月,我们对11例非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass graft,OPCABG)施行LSV取材,采用仰卧位,屈膝90°,屈髋45°,借助弹力绷带缠绕膝关节下部并向对侧牵拉,形成髋关节内旋30°~45°体位。从外踝后方切口找到LSV后,沿其走行向小腿后方中线延长切口,查验LSV的长度和质量后,移植血管分别与升主动脉和靶血管行端侧吻合,完成OPCABG。测量LSV的长度和直径,流量仪测量桥路流量值和搏动指数(Pulsatility Index,PI)。结果11例均顺利完成单侧LSV取材术,血管长度17~26 cm,(22.5±2.8)cm,血管直径2.0~3.7 mm,(3.1±0.5)mm。1例女性患者因LSV管径过细而放弃使用;余10例以LSV完成单根血管吻合:1例对角支、3例后降支和6例回旋支。9例用流量仪测量LSV桥路流量和PI:流量25~58 ml/min,(39.4±11.2)ml/min;PI 1.1~2.0,(1.52±0.30)。11例LSV取材部位切口愈合良好,顺利康复出院。10例LSV取材术后3个月电话随访,均恢复良好,心肌缺血症状消失,纽约心脏协会(New York Heart Association,NYHA)心脏功能分级,Ⅰ级8例,Ⅱ级2例。结论屈膝屈髋、髋关节内旋体位可以安全、便捷地用于LSV取材术。Objective To explore the safety and feasibility of lesser saphenous vein(LSV)harvesting with the operative posture of flexion at the knee and hip level and internal rotation at the hip joint.Methods Between January 2014 and October 2022,11 patients underwent off-pump coronary artery bypass graft(OPCABG)with LSV harvesting.The LSV was harvested with supine position of the patient on the table,which was in flexion 90°at the knee level and 45°at the hip level,and from 30°to 45°internal rotation at the hip joint under the stretch of elastic bandage rounding the calf.After finding the LSV from the posterior incision of the lateral malleolus,the incision was extended to the posterior midline of the calf along the LSV.Once the vein was harvested and deemed to be macroscopical suitable both in terms of length and quality,the OPCABG operation was continued in the normal fashion and the LSV was end-to-side anastomosised with ascending aorta and target vessel respectively.The length and the diameter of the LSV were measured during the operation.The LSV bridge flow value and pulsatility index(PI)value were measured by flow meter.Results The 11 patients underwent LSV harvesting without injury.The length of LSV ranged from 17 cm to 26 cm(average,22.5±2.8 cm),and the diameter ranged from 2.0 mm to 3.7mm(average,3.1±0.5 mm).In 1 female patient,the diameter of LSV was 2 mm,and it was abandoned because the diameter of the tube was too thin.The other 10 patients received LSV for single-vessel anastomosis to the target vessel,including 1 case of diagonal branch,3 cases of posterior descending branch,and 6 cases of circumflex branch.The LSV bridge flow value and PI value were measured with flow meter in 9 patients.The flow values of 9 cases ranged from 25 ml/min to 58 ml/min(average,39.4±11.2 ml/min)and the PI values ranged from 1.1 to 2.0(average,1.52±0.30).All the patients were discharged with wounds healed well.These 10 patients recieving LSV harvesting were followed up by phone at 3 months after surgery,all of which recov

关 键 词：小隐静脉 冠状动脉粥样硬化性心脏病 非体外循环冠状动脉旁路移植术 

分 类 号：R654.2[医药卫生—外科学]