关键词: 冠状动脉旁路移植术, 大隐静脉, 内窥镜, 组织学

Abstract: Objective To observe the effects of endoscopic saphenous vein harvesting technique on the prevalence of leg-wound complications after coronary artery bypass grafting, and assess the feasibility of this technique and the potential trauma of the conduits. Methods Between January 2007 and February 2008, 118 patients underwent primary coronary artery bypass grafting, and 40 patients''saphenous vein taken using endoscopic harvest system(EVH), and the others by open vein harvesting(OVH), based on patient's willingness. The operation risk factors were compared between the two groups, and the proximal vein segment that underwent endoscopic harvesting was examined with electron-microscope. 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 the EVH group(12.5%) than in the OVH group(39.7%)(P<0.01). The time of harvesting was similar between the two groups. The length of conduits was(30.3±7.45)cm and (37.7±8.01)cm with significant difference between the two groups(P<0.05). Actually, there was increase in the use of sequential grafting technique in the EVH group for revascularization. Histological studies suggested that there were no extra vein trauma associated with EVH. At the same time, we have accumulated rich experience and skills in this procedure, and realized anatomical features of vein grafts. However, because of limited experience, the patency rate of conduits and the incidence rate of myocardial infarction in the perioperative or postoperative period were not compared between the two groups, more precise observations might be required. Conclusion The decrease in incision complications of EVH was unquestionably superior to those of OVH, especially for those patients having risk factors of incision complications. With increasing experience, the EVH technique might replace conventional saphenous vein harvesting methods and become the standard option.

Key words: coronary artery bypass grafting, great saphenous vein, endoscope, histology