间断切口与长切口获取大隐静脉在冠状动脉旁路移植术中作用的对比研究

目的:比较冠状动脉旁路移植术(CABG)中采用间断切口与长切口获取大隐静脉作为静脉桥材料的优缺点。方法:选择2011年12月至2012年12月宁夏医科大学总医院心脏大血管外科111例行CABG的冠状动脉粥样硬化性心脏病患者为研究对象。根据术中获取大隐静脉方法的不同,随机将其分为两组,长切口组64例,在CABG中采用长切口法获取大隐静脉,间断切口组47例,在CABG中采用间断切口法获取大隐静脉。比较两组大隐静脉获取时间、下肢切口缝合时间、下肢手术时间、大隐静脉桥长度、下肢切口长度和下肢切口并发症发生率的差异。结果:间断切口组大隐静脉桥长度及下肢手术时间(45.4±6.7)cm,(65.8±10.3)min与长切口组(47.5±6.7)cm,(65.8±10.3)min比较无统计学差异(P0.05)。间断切口组获取大隐静脉的时间(48.9±8.3)min显著长于长切口组(37.3±5.8)min,下肢切口长度与缝合时间(17.0±3.5)cm,(16.9±3.4)min明显短于长切口组的(43.5±6.4)min,(31.7±5.9)min,差异均有统计学意义(P0.05)。两组大隐静脉壁的损伤情况比较无统计学差异(P0.05),但间断切口组术后下肢切口延迟愈合、感染、渗出、下肢血肿等并发症的发生率低于长切口组(P0.05)。结论:在冠状动脉旁路移植术中,间断切口获取大隐静脉能够显著缩短下肢手术切口长度,有助于减少术后下肢切口感染、延迟愈合、渗出、下肢血肿等并发症的发生。

Comparative Study on the effect of Intermittent Incision and Long Incision for Great Saphenous Vein Harvesting in the Coronary Artery Bypass Graft Surgery

Objective： To compare the advantages and disadvantages of intermittent incision and long incision to harvest great saphenous vein （GSV） as vein bridge material in the coronary artery bypass graft （CABG） surgery. Methods： From December 2011 to December 2012, 111 cases of coronary atherosclerotic heart disease patients underwent CABG were divided into two groups according to the intermittent incision and long incision for achieving GSV. The GSV harvesting time, lower limbs suture time, lower limbs operation time, incision length, GSV length, quality of GSV and incision complications Were compared. Results： No statistical difference of GSV length, lower limb surgery time between incision group （45.4± 6.7）cm,（65.8± 10.3）min and long incision group （47.5± 6.7）cm,（65.8± 10.3）min was found,（P〉0.05）. The GSV harvesting time of intermittent incision group （48.9± 8.3）min was significantly longer than that in the long incision group （48.9± 8.3）min, However, the incision length and suture time of intermittent incision group （17.0± 3.5）cm, （16.9± 3.4 ）rain were both significantly shorter than those in the long incision group （43.5± 6.4）min, （31.7± 5.9）min, （P〈0.05）. There was no statistical difference in the number of injured GSV between the two groups,（P 〉0.05）. The complication rate of the long incision group was higher than that in the intermittent incision group （P〈0.05）. Conclusion： In the CABG, Intermittent incision harvesting GSV could shorten the lower limb incision length, reduce postoperative Complication rate, such as lower limb incision infection, delayed healing, seepage, or ower limb hematoma.