微创静脉桥获取术在冠脉搭桥术中的应用及学习曲线
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Initial application and learning curve of endoscopic saphenous vein harvesting during coronary artery bypass grafting
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    摘要:

    目的研究冠脉搭桥术中应用内窥镜获取大隐静脉的可行性,探讨住院医师学习此项技术的学习曲线。方法选取北京宣武医院2007年1月至2008年2月间行择期冠脉搭桥术118例,分为内窥镜大隐静脉获取术(EVH)组40例,全程切开大隐静脉获取术(OVH)组78例。对其高危因素,术后并发症进行比较,并对EVH组所取静脉进行组织学评价。EVH组患者,按手术时间先后分4个亚组(G1~G4),每组10例,比较获取时间、静脉长度、手术结果等情况。结果两组患者在下肢切口并发症的高危因素上无差别,但并发症的总发生率有显著差别。两组各有1例死亡,均死于术后循环衰竭。两组静脉获取时间相当,获取的静脉长度比较有差别。两组术后住院时间无明显差别,但费用有显著差别。4个亚组在静脉长度上无明显差异,长度-时间指数由G1组的0.41±0.08显著提高到G4组的0.75±0.06,这一变化代表了微创EVH的学习曲线。结论微创EVH作为一种新兴技术有着广泛的应用前景,在降低术后下肢伤口并发症上有明显优势,尤其适用于存在高危因素的患者。但对它的熟练掌握需要一个学习过程。?更多还原

    Abstract:

    Objective To assess the feasibility of endoscopic saphenous vein harvesting (EVH) and discuss the learning curve of this technique during coronary artery bypass grafting. Methods One hundred and eighteen patients,who underwent primary coronary artery bypass grafting between January 2007 to February 2008,were divided into two groups: EVH group (n=40) and open saphenous vein harvesting (OVH) group (n=78). The risk factors and incision complications were compared between the two groups. The proximal vein segment in EVH group was examined histologically. Forty patients in EVH group were further divided into 4 subgroups (G1,G2,G3,G4) according to the operation sequence,with 10 in each. The operation time duration,the length of conduit,and the overall results were compared between the subgroups. Results There was no significant difference in risk factors of incision complications between the two groups,but the incidence of various incision complications was significantly lower in EVH group than in OVH group (12.5% vs 39.7%,P<0.01). There was one death due to postoperative heart failure in each group respectively. There was no difference in operation time duration and postoperative hospitalization time between EVH and OVH groups,but the length of conduit and the treatment cost were significantly different between two groups. The length-time index was increased significantly from 0.41±0.08 in subgroup G1 to 0.75±0.06 in subgroup G4,which represented the learning curve of EVH. Conclusion As a newly emerging technique,EVH has a great promise for its wide application. A definite learning curve is needed for skillful manipulation.?更多

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徐东 李洪利 张科峰 尚学斌 刘燕晖 刘飞 姚青.微创静脉桥获取术在冠脉搭桥术中的应用及学习曲线[J].中华老年多器官疾病杂志,2009,8(6):536~540

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